A Child-Centred Health Dialogue for the prevention of obesity : Feasibility and evaluation of a structured model for the promotion of a healthy lifestyle in preschool children and their families in the Swedish Child Health Services

Prevention of childhood obesity with its effects on children’s mental and physical health and well-being is an international public health priority and is suggested to be effective when started early. As Child Health Services lack an evidence-based model, there is the need for development of a low-intensive health promotion model that is feasible and cost-effective in preventing obesity in preschool children.The overall aim of this study was to develop an evidence-based child-centred multicomponent model that can be used in the Child Health Services with the aim of promoting a healthy lifestyle in families and preventing obesity in preschool children. The Medical Research Council’s guidelines for developing complex interventions were used to design two studies. A feasibility study was set up with a quasi-experimental cluster design comparing usual care with a structured Child-Centred Health Dialogue (CCHD). A total of 203 children at three Child Health Centres received the intervention and were compared to a register-control group at eight matched centres consisting of 582 children. The results showed that both the universal and the targeted part of CCHD were feasible. Training and recurrent tutorial sessions with room for reflection strengthened nurses’ confidence and security in executing CCHD.In a cluster-randomised controlled trial including an economic evaluation, 37 Child Health Centres were randomly assigned to deliver usual care or CCHD. A total of 6,047 children with a mean age of 4.1 years [SD=0.1] were included, consisting of 4,598 children with normal weight and 490 children with overweight. At follow‐up, at a mean age of 5.1 years [SD=0.1], there was no intervention effect on zBMI‐change for children with normal weight. In children with overweight the intervention effect on zBMI‐change was -0.11(95% CI: -0.24 to 0.01; p=0.07). The estimated additional costs for children with overweight were 167 euros per child with overweight.Qualitative interviews and non-participatory observations exploring the experiences of 21 children who participated in CCHD showed that children participated as social actors and wanted to understand the meaning of the health information. The study revealed that 4-year-old children given the opportunity to speak for themselves interpreted some of the illustrations, developed by adults differently from the intended meaning.Parents of 1,197 children, including 1,115 mothers and 869 fathers, responded to a survey that measured perceived parental self-efficacy. Mothers showed an intervention effect on perceived self-efficacy in promoting physical activity of 0.5 (95% CI: 0.04 to 1.0; p=0.046). A subgroup of mothers with increased self-efficacy showed an intervention effect on zBMI-change in normal weight children of -0.13 (95% CI: -0.26 to -0.01; p=0.04) and a decreasing tendency in zBMI-change of -0.50 (95% CI: -1.08 to 0.07; p=0.08) in children with overweight or obesity. To conclude, the intervention performed in a real-life setting did not show an effect on zBMI in children with normal weight, but demonstrated a decreasing tendency in zBMI in children with overweight 12 months after the intervention, albeit statistically uncertain. The additional costs for the provision of CCHD and the training of health professionals in the model could be considered a cost-effective investment in the future health of children with overweight. This thesis supports the view that children are capable of making health information meaningful and can take an active role in their health. It demonstrates the importance of a child-centred approach, respecting children as social actors in the context of their families and using tools that strengthen the child’s and the family’s health literacy

Fetal abdominal cysts: antenatal course and postnatal outcomes

Background There is little information on which to base the prognostic counselling as to whether an antenatally diagnosed fetal abdominal cyst will grow or shrink, or need surgery. This study aims to provide contemporary data on prenatally diagnosed fetal abdominal cysts in relation to their course and postnatal outcomes. Methods Fetal abdominal cysts diagnosed over 11 years in a single centre were identified. The gestational age at diagnosis and cyst characteristics at each examination were recorded (size, location, echogenity, septation and vascularity) and follow-up data from postnatal visits were collected. Results Eighty abdominal cysts were identified antenatally at 28+4 weeks (range 11+0-38+3). Most (87%) were isolated and the majority were pelvic (52%), simple (87.5%) and avascular (100%). Antenatally, 29% resolved spontaneously; 29% reduced in size; 9% were stable and 33% increased in size. Forty-one percent of cysts under 20 mm diameter increased in size, while only 20% of cysts with a diameter of over 40 mm increased in size. The majority of cysts were ovarian in origin (n=45, 56%), followed by intestinal (n=15, 18%), choledochal (n=3, 4%), liver (n=2, 3%) and renal/adrenal origins (n=2, 3%), respectively. In 16% (n=13), the antenatal diagnosis was not obvious. Seventy-five percent of the cysts that persisted postnatally required surgical intervention. Conclusions Most antenatally diagnosed fetal abdominal cysts were ovarian in origin. Though most disappeared antenatally, nearly three quarters required surgical intervention when present after birth. Cysts of intestinal origin are more difficult to diagnose antenatally and often require surgery

Separating fetal and maternal placenta circulations using multiparametric MRI

PURPOSE: The placenta is a vital organ for the exchange of oxygen, nutrients, and waste products between fetus and mother. The placenta may suffer from several pathologies, which affect this fetal-maternal exchange, thus the flow properties of the placenta are of interest in determining the course of pregnancy. In this work, we propose a new multiparametric model for placental tissue signal in MRI.METHODS: We describe a method that separates fetal and maternal flow characteristics of the placenta using a 3-compartment model comprising fast and slowly circulating fluid pools, and a tissue pool is fitted to overlapping multiecho T2 relaxometry and diffusion MRI with low b-values. We implemented the combined model and acquisition on a standard 1.5 Tesla clinical system with acquisition taking less than 20 minutes.RESULTS: We apply this combined acquisition in 6 control singleton placentas. Mean myometrial T2 relaxation time was 123.63 (±6.71) ms. Mean T2 relaxation time of maternal blood was 202.17 (±92.98) ms. In the placenta, mean T2 relaxation time of the fetal blood component was 144.89 (±54.42) ms. Mean ratio of maternal to fetal blood volume was 1.16 (±0.6), and mean fetal blood saturation was 72.93 (±20.11)% across all 6 cases.CONCLUSION: The novel acquisition in this work allows the measurement of histologically relevant physical parameters, such as the relative proportions of vascular spaces. In the placenta, this may help us to better understand the physiological properties of the tissue in disease.</p

Accelerated V2X provisioning with Extensible Processor Platform

With the burgeoning Vehicle-to-Everything (V2X) communication, security and privacy concerns are paramount. Such concerns are usually mitigated by combining cryptographic mechanisms with suitable key management architecture. However, cryptographic operations may be quite resource-intensive, placing a considerable burden on the vehicle’s V2X computing unit. To assuage this issue, it is reasonable to use hardware acceleration for common cryptographic primitives, such as block ciphers, digital signature schemes, and key exchange protocols. In this scenario, custom extension instructions can be a plausible option, since they achieve fine-tune hardware acceleration with a low to moderate logic overhead, while also reducing code size. In this article, we apply this method along with dual-data memory banks for the hardware acceleration of the PRESENT block cipher, as well as for the $F_{2^{255}-19}$ finite field arithmetic employed in cryptographic primitives based on Curve25519 (e.g., EdDSA and X25519). As a result, when compared with a state-of-the-art software-optimized implementation, the performance of PRESENT is improved by a factor of 17 to 34 and code size is reduced by 70%, with only a 4.37% increase in FPGA logic overhead. In addition, we improve the performance of operations over Curve25519 by a factor of ~2.5 when compared to an Assembly implementation on a comparable processor, with moderate logic overhead (namely, 9.1%). Finally, we achieve significant performance gains in the V2X provisioning process by leveraging our hardware-accelerated cryptographic primitive

Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol

Introduction: Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. Methods and analysis: Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is &lt;10th percentile or has decreased by 50 percentiles since 18-32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children's Abilities-Revised questionnaire. Ethics and dissemination: The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. Trial registration number: Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical &amp; Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200

A Child-Centred Health Dialogue for the prevention of obesity [Elektronisk resurs] : Feasibility and evaluation of a structured model for the promotion of a healthy lifestyle in preschool children and their families in the Swedish Child Health Services

Barnobesitas är sedan flera år ett ökat hälsoproblem bland barn. Obesitas vid 4 års ålder ger en kraftigt ökad risk för obesitas senare i livet. Att förebygga uppkomst och utveckling av obesitas är en långsiktig investering för framtiden. Idag finns ingen evidensbaserad metod för vägledning inom barnhälsovården för att främja hälsosamma levnadsvanor och förebygga obesitas hos förskolebarn. Det övergripande syftet med denna avhandling var att utveckla en evidensbaserad och barncentrerad samtalsmodell som kan användas inom barnhälsovården för att främja hälsosamma levnadsvanor och förebygga obesitas. Avhandlingsarbetet utgick från ett metodologiskt ramverk för att utveckla komplexa interventioner i hälso- och sjukvård. En strukturerad samtalsmodell “Grunda Sunda Vanors barncentrerade hälsosamtal” utvecklades baserad på en systematisk genomgång av tidigare forskning och med teoretisk utgångspunkt i barncentrerad vård, i hälsolitteracitet och i föräldrars tillit till sin förmåga att främja hälsosamma levnadsvanor hos sitt barn. Samtalsmodellen består av två delar: 1) ett universellt barncentrerat hälsosamtal som utgår från ett interaktivt bildmaterial med de viktigaste levnadsvanor som påverkar barns viktutveckling och barnets BMI-kurva vid barnets 4-årsbesök på barnavårdscentralen (BVC) och 2) ett riktat vägledande familjesamtal för familjer där ett barn identifierats med övervikt eller obesitas. Sjuksköterskor fick en dags utbildning och återkommande reflekterande handledningstillfällen för att tillägna sig hälsosamtalets förhållningssätt, struktur och verktyg. I en studie där genomförbarheten av samtalsmodellen studerades erhöll 203 fyraåriga barn vid tre BVC Grunda Sunda Vanors barncentrerade hälsosamtal. Dessa jämfördes med 582 barn som erhöll traditionell vård vid åtta BVC. Resultatet visade att både den universella och den riktade delen av modellen var genomförbara. Utbildning och återkommande handledningssessioner med utrymme för reflektion utvecklade sjuksköterskornas arbetssätt och underlättade samtalet om övervikt. I en klusterrandomiserad kontrollerad studie som inkluderade barn med normal vikt och övervikt utvärderades samtalsmodellens effekt på standardiserat BMI (standar-diserat utifrån barnets ålder och kön) i jämförelse med traditionell vård samt kostnader och kostnadseffektivitet analyserades. Totalt 6 047 fyraåriga barn, varav 4 598 barn med normalvikt och 490 barn med övervikt, deltog vid 35 BVC. Vid uppföljning ett år efter 4-årsbesöket sågs ingen effekt på standardiserat BMI för barn med normalvikt. Barn med övervikt som hade fått Grunda Sunda Vanors barncentrerade hälsosamtal visade en tendens till minskning i standardiserat BMI, om än statistiskt osäkert. Det fanns även en tendens till minskad förekomst av obesitas 12 månader efter det barncentrerade hälsosamtalet hos barn med övervikt. Inget barn utvecklade undervikt. De uppskattade kostnaderna för barn med övervikt, beräknade ur ett samhällsper-spektiv, var lägre för barn som erhöll den nya samtalsmodellen än kostnaderna för barn med övervikt som fick traditionell vård, vilket framförallt kan förklaras av skillnader i antal remisser till andra vårdgivare. Sjuksköterskorna som var utbildade i den nya samtalsmodellen kände sig mer kunniga i barnövervikt och mer kompetenta i kommunikationsmetoden. Observationer och intervjuer med 21 barn som fick det barncentrerade hälsosamtalet visade att barn ville delta aktivt som sociala aktörer i hälsosamtalet. Barnen uttryckte upplevelser från sin vardag och ville förstå innebörden av hälsobudskapet. Resultatet visade att barnen ibland tolkade hälsoinformationen på bilderna på ett annat sätt än vad som avsågs. Föräldrar till 1 197 barn, 1 115 mödrar och 869 fäder, svarade på enkäter om tilltro till sin förmåga att främja hälsosamma levnadsvanor för sitt barn. Mödrar som hade fått erfarenhet av den nya samtalsmodellen visade en svag positiv utveckling i upplevd tilltro till sin förmåga att främja fysisk aktivitet till sina barn i jämförelse med mödrar som hade fått traditionell vård. Hos mödrar med ökad upplevd tilltro till sin förmåga att främja hälsosamma matvanor ett år efter samtalet fanns en gynnsam utveckling av barnens standardiserade BMI, framförallt hos barn med normal vikt, men det fanns även en positiv tendens dock statistiskt osäker bland barn med övervikt eller obesitas. Sammanfattningsvis visade studierna ingen effekt på standardiserat BMI hos barn med normal vikt, men en tendens till minskning i standardiserat BMI hos barn med övervikt 12 månader efter att Grunda Sunda Vanors barncentrerade hälsosamtal genomförts. Den uppskattade merkostnaderna för att utföra och utbilda vårdpersonalen i samtalsmodellen bedöms som en kostnadseffektiv investering i den framtida hälsan för barn med övervikt. Utbildning och återkommande handledning stärkte sjuksköterskors självförtroende och trygghet i att utföra samtalsmodellen. Barnen kunde vara delaktiga i hälsosamtalet och tolka kritiskt hälsoinformationen utifrån sina egna tankar och upplevelser. Avhandlingsarbetet styrker vikten av att respektera barn som sociala aktörer i sitt sammanhang och att inkludera barnets perspektiv i forskning samt betydelsen av att använda bildmaterial som stärker barnets och familjens hälsolitteracitet. Framtida studier bör fokusera på förebyggande insatser, inte bara på individnivå, utan även på insatser som inkluderar ett brett samarbete mellan många olika sektorer på alla olika nivåer i samhället.Prevention of childhood obesity with its effects on children’s mental and physical health and well-being is an international public health priority and is suggested to be effective when started early. As Child Health Services lack an evidence-based model, there is the need for development of a low-intensive health promotion model that is feasible and cost-effective in preventing obesity in preschool children. The overall aim of this study was to develop an evidence-based child-centred multicomponent model that can be used in the Child Health Services with the aim of promoting a healthy lifestyle in families and preventing obesity in preschool children. The Medical Research Council’s guidelines for developing complex interventions were used to design two studies. A feasibility study was set up with a quasi-experimental cluster design comparing usual care with a structured Child-Centred Health Dialogue (CCHD). A total of 203 children at three Child Health Centres received the intervention and were compared to a register-control group at eight matched centres consisting of 582 children. The results showed that both the universal and the targeted part of CCHD were feasible. Training and recurrent tutorial sessions with room for reflection strengthened nurses’ confidence and security in executing CCHD. In a cluster-randomised controlled trial including an economic evaluation, 37 Child Health Centres were randomly assigned to deliver usual care or CCHD. A total of 6,047 children with a mean age of 4.1 years [SD=0.1] were included, consisting of 4,598 children with normal weight and 490 children with overweight. At follow‐up, at a mean age of 5.1 years [SD=0.1], there was no intervention effect on zBMI‐change for children with normal weight. In children with overweight the intervention effect on zBMI‐change was -0.11(95% CI: -0.24 to 0.01; p=0.07). The estimated additional costs for children with overweight were 167 euros per child with overweight. Qualitative interviews and non-participatory observations exploringthe experiences of 21 children who participated in CCHD showed that children participated as social actors and wanted to understand the meaning of the health information. The study revealed that 4-year-old children given the opportunity to speak for themselves interpreted some of the illustrations, developed by adults differently from the intended meaning. Parents of 1,197 children, including 1,115 mothers and 869 fathers, responded to a survey that measured perceived parental self-efficacy. Mothers showed an intervention effect on perceived self-efficacy in promoting physical activity of 0.5 (95% CI: 0.04 to 1.0; p=0.046). A subgroup of mothers with increased self-efficacy showed an intervention effect on zBMI-change in normal weight children of -0.13 (95% CI: -0.26 to -0.01; p=0.04) and a decreasing tendency in zBMI-change of -0.50 (95% CI: -1.08 to 0.07; p=0.08) in children with overweight or obesity. To conclude, the intervention performed in a real-life setting did not show an effect on zBMI in children with normal weight, but demonstrated a decreasing tendency in zBMI in children with overweight 12 months after the intervention, albeit statistically uncertain. The additional costs for the provision of CCHD and the training of health professionals in the model could be considered a cost-effective investment in the future health of children with overweight. This thesis supports the view that children are capable of making health information meaningful and can take an active role in their health. It demonstrates the importance of a child-centred approach, respecting children as social actors in the context of their families and using tools that strengthen the child’s and the family’s health literacy