OBJECTIVE: To examine the relationship between prenatal alcohol exposure (PAE) and children\'s behavioural and emotional development in a large generalizable sample of women and their children in Aotearoa New Zealand.
METHODS: Using data from the Growing Up in New Zealand longitudinal cohort, we investigated the relationship between maternal PAE and behavioural and emotional development in 8-year-old children. We explored secondary outcomes including measures of language, executive function, academic achievement, and adaptive behaviour.
RESULTS: We found no significant differences in the measures of behavioural and emotional development in children 8 years old based on alcohol consumption. No significant differences in behavioural and emotional development were found based on amount of PAE and when PAE occurred, despite controlling for a range of potential confounding factors, such as neighbourhood deprivation and maternal health measures. PAE was associated with significantly higher scores for parent-rated oral language indicating better oral language. In Māori mothers, PAE was significantly associated with an increased risk of higher scores on two of the Strengths and Difficulties Questionnaire subscales.
CONCLUSIONS: We did not find an association between PAE and behavioural and emotional development in children aged 8 years. PAE and behavioural and emotional development are difficult to measure accurately, and the moderating variables between them are complex. Future analyses will require larger cohorts of mothers and their children using precise measures of PAE and outcomes to enable more precise estimates of association.

The programme aimed to improve selected cardiometabolic risk (CMR) variables using a nutritional intervention among farmers who reported hypertensive disorders as hindrances during agricultural activities. The intervention had two case controls (n = 103) [experimental group-EG (n = 53) and control group-CG (n = 50)] which were tracked and whose blood pressure measurements, dietary intake, blood indices for cholesterol concentration and glucose levels from pre- and post-intervention surveys after the baseline survey (n = 112) were analysed. The interval for data collection was 12 weeks (±120 days) after five legume varieties were consumed between 3 and 5 times a day, and servings were not <125 g per at least three times per week. Sixty-five per cent of farmers were above 60 years old, with mean age ranges of 63.3 (SD ± 6.3) years for women and 67.2 (SD ± 6.7) for men. The post-intervention survey revealed that EG blood results indicated nutrient improvement with p <= 0.05 for blood glucose (p = 0.003) and cholesterol (p = 0.001) as opposed to the CG. A trend analysis revealed that cholesterol (p = 0.033) and systolic blood pressure (SBP); (p = 0.013) were statistically significant when comparing genders for all study phases. Interventions focusing on legumes can improve hypertension and cardiovascular disease and fast-track the achievement of SGDs 3 and 12 through community-based programmes.

BACKGROUND: Social media is rapidly becoming the primary source to disseminate invitations to the public to consider taking part in research studies. There is, however, little information on how the contents of the advertisement can be communicated to facilitate engagement and subsequently promote intentions to participate in research.
OBJECTIVE: This paper describes an experimental study that tested different behavioral messages for recruiting study participants for a real-life observational case-control study.
METHODS: We included 1060 women in a web-based experiment and randomized them to 1 of 3 experimental conditions: standard advertisement (n=360), patient endorsement advertisement (n=345), and social norms advertisement (n=355). After seeing 1 of the 3 advertisements, participants were asked to state (1) their intention to take part in the advertised case-control study, (2) the ease of understanding the message and study aims, and (3) their willingness to be redirected to the website of the case-control study after completing the survey. Individuals were further asked to suggest ways to improve the messages. Intentions were compared between groups using ordinal logistic regression, reported in percentages, adjusted odds ratio (aOR), and 95% CIs.
RESULTS: Those who were in the patient endorsement and social norms-based advertisement groups had significantly lower intentions to take part in the advertised study compared with those in the standard advertisement group (aOR 0.73, 95% CI 0.55-0.97; P=.03 and aOR 0.69, 95% CI 0.52-0.92; P=.009, respectively). The patient endorsement advertisement was perceived to be more difficult to understand (aOR 0.65, 95% CI 0.48-0.87; P=.004) and to communicate the study aims less clearly (aOR 0.72, 95% CI 0.55-0.95; P=.01). While the patient endorsement advertisement had no impact on intention to visit the main study website, the social norms advertisement decreased willingness compared with the standard advertisement group (157/355, 44.2% vs 191/360, 53.1%; aOR 0.74, 95% CI 0.54-0.99; P=.02). The majority of participants (395/609, 64.8%) stated that the messages did not require changes, but some preferred clearer (75/609, 12.3%) and shorter (59/609, 9.7%) messages.
CONCLUSIONS: The results of this study indicate that adding normative behavioral messages to simulated tweets decreased participant intention to take part in our web-based case-control study, as this made the tweet harder to understand. This suggests that simple messages should be used for participant recruitment through Twitter (subsequently rebranded X).

This study tested the efficacy of a 5 × 1.5 h/session, group-based, parent-focused, behavioural intervention (BI) targeting sleep problems in preschool children. Parents were randomised to either the BI (N = 62) or care as usual (CAU; N = 66) conditions. Outcomes included sleep, anxiety, behavioural problems, internalising and externalising symptoms, transition to school and academic achievement. Assessments were conducted at pre- and post-BI intervention (in the year prior to formal schooling), and then at follow-ups 1 and 2 in the first year of formal schooling. Relative to the CAU, the BI condition demonstrated significantly greater improvements in sleep, anxiety, behaviour problems and internalising and externalising symptoms from pre-to post-intervention. Improvements in sleep, anxiety, and internalising symptoms were maintained, while behaviour and externalising symptoms were further improved upon at school follow-up 2. For the BI group, improvements in sleep at post-intervention were found to mediate improvements in anxiety, internalising, and externalising symptoms, but not behaviour problems, at school follow-ups 1 and 2. There were no significant effects of condition on school transition or academic outcome measures. The results suggest that the BI is effective for sleep, anxiety, behaviour, internalising and externalising symptoms, but not for school transition or academic outcomes. ANZCTR NUMBER: ACTRN12618001161213.

UNASSIGNED: Antimicrobial resistance poses a major public health threat. Despite Indian retail sector antibiotic consumption per capita increasing by approximately 22% between 2008 and 2016, empirical studies that examine policy or behavioural interventions addressing antibiotic misuse in primary healthcare are scarce. Our study aimed to assess perceptions of interventions and gaps in policy and practice with respect to outpatient antibiotic misuse in India.
UNASSIGNED: We conducted 23 semi-structured, in-depth interviews with a variety of key informants with diverse backgrounds in academia, non-government organisations, policy, advocacy, pharmacy, medicine and others. Data were charted into a framework matrix and analysed using a hybrid, inductive and deductive thematic analysis. Themes were analysed and organised according to the socio-ecological model at various levels ranging from the individual to the enabling environment.
UNASSIGNED: Key informants largely focused on the importance of adopting a structural perspective to addressing socio-ecological drivers of antibiotic misuse. There was a recognition that educational interventions targeting individual or interpersonal interactions were largely ineffective, and policy interventions should incorporate behavioural nudge interventions, improve the healthcare infrastructure and embrace task shifting to rectify staffing disparities in rural areas.
UNASSIGNED: Prescription behaviour is perceived to be governed by structural issues of access and limitations in public health infrastructure that create an enabling environment for antibiotic overuse. Interventions should move beyond a clinical and individual focus on behaviour change with respect to antimicrobial resistance and aim for structural alignment between existing disease specific programs and between the informal and formal sector of healthcare delivery in India.

BACKGROUND: Neurodevelopmental difficulties with various emotional and behavioral symptoms increase the risk of mental health problems later in life. Although we know that early detection and interventions are effective, there is a lack of intersectoral, integrative, and evidence-based working models to provide these services for preschool children and their parents. PLUSS (Psykisk hälsa Lärande Utveckling Samverkan kring Små barn; English translation: mental health, learning, development, collaboration around preschool children) is a collaborative \"one way in\" model involving parents, health care providers, preschools, social services, and researchers. PLUSS provides coordinated services to screen, evaluate, and support toddlers with neurodevelopmental problems. It also offers parental interventions and education for preschool teachers.
OBJECTIVE: The model will be studied in a research project that aims to investigate (1) using a quasi-experimental study on longitudinal trajectories of neurodevelopmental difficulties and ability to function among participating preschoolers, (2) user satisfaction, and (3) implementation of the model and its effectiveness. The long-term goal is to provide evidence-based, coordinated services to reduce problems related to neurodevelopmental difficulties among preschool children and promote well-being and functioning in everyday life.
METHODS: The population of interest is children aged 1.5-5 years, whom the child health care nurse refers for further assessment due to suspected neurodevelopmental problems. Data are collected using questionnaires and semistructured interviews. Measures include sociodemographic data, longitudinal data on neurodevelopmental problems, parental well-being and satisfaction, the effectiveness of parental and preschool teacher training and implementation of the model, and fostered multisectoral collaborations. Data will be analyzed with qualitative and quantitative methods.
RESULTS: The PLUSS model has been approved by the National Ethics Review Board (2019-04839). This study was supported by FUTURUM grants 910161 and 910441. Data collection started in April 2019, with the data collection period planned to end in May 2024.
CONCLUSIONS: PLUSS is an integrative working model with multiprofessional competence and intersectoral collaboration capacity to help preschool children with neurodevelopmental problems and their parents. It will be studied using quasi-experimental cross-sectional and longitudinal study designs. Data will be collected from parents, health care providers, and preschool teachers, and will be analyzed using quantitative and qualitative methods. The study will run in one Swedish county, and generalizability needs to be studied separately. Loss of follow-up could impact the longitudinal analysis.
BACKGROUND: ClinicalTrials.gov NCT04815889; https://clinicaltrials.gov/ct2/show/NCT04815889.
UNASSIGNED: DERR1-10.2196/34969.

Children with severe needle phobia find vaccination extremely distressing and can remain unvaccinated, which puts them at an increased risk of contracting and transmitting vaccine preventable disease. Referral to a specialist or hospital service may occur when they cannot be safely vaccinated in the community, but engagement of allied health services can be inconsistent. The aim of the study was to assess the impact of a multidisciplinary, consumer-oriented model of care on vaccinations for needle phobic children.
Needle phobic children aged between 6 and 16 years attended multidisciplinary consultation, as part of a care package, to assess previous experiences and determine the level of intervention that was required to support vaccination. A multidisciplinary case meeting followed this appointment and an individualised plan formulated for each patient. The main outcome of the project was rate of successful vaccination.
The care package resulted in a successful vaccination rate of 83% (n = 20) with 69 vaccines administered across three clinics. Of those successful, 90% required multiple injections per visit. The majority of patients indicated moderate to high level of anxiety. Supportive care was escalated and de-escalated as tolerated.
Results demonstrate the diversity of patients presenting with needle phobia and indicate an individualised, collaborative approach is preferable to a \'one size fits all\' model of care. The study highlights a need for the development of guidelines that streamline the assessment and individualisation of procedural anxiety plans to meet patient needs and embed these processes into standard care.

OBJECTIVE: The ACTIVE intervention uses a novel fatigue propensity tool to target a behavioural fatigue self-management programme for women undergoing radiotherapy for early breast cancer. We assess feasibility and outcomes for ACTIVE.
METHODS: Mixed methods comprised a randomised feasibility trial with qualitative process evaluation and a nested fatigue risk substudy. Participants at a higher risk of fatigue were allocated 2:1 to behavioural intervention or information alone. Participants at a lower risk of fatigue entered the fatigue risk substudy. Feasibility was assessed by rates of eligibility, recruitment, retention and adherence. Qualitative interviews explored acceptability of the intervention and trial processes. Measures of fatigue, anxiety, depression, quality of life and self-efficacy were self-reported before, during and 10 days, 3 weeks and 6 months after radiotherapy. Pre-treatment fatigue risk score and post-treatment fatigue were correlated.
RESULTS: Fifty percent (n = 75) of eligible patients were recruited with 33 higher risk participants randomised to the trial and 42 entering the fatigue risk score substudy. Trial design and methods were feasible and acceptable with 91% of participants completing all measures according to protocol. Fatigue was clinically-significantly lower in the intervention group during, and in the weeks after, treatment compared to the control: all secondary measures favoured the intervention group. Positive group differences were not maintained at 6 months.
CONCLUSIONS: Our targeted approach to fatigue self-management is feasible and acceptable within the early breast cancer pathway. Multiple benefits were reported by patients who received the intervention, which is worthy of further investigation.
BACKGROUND: ISRCTN 10303368. Registered August 2017. Health and Care Research Wales Clinical Trial Portfolio Registration 31419.

The need to enhance mental health in primary care settings for infants and toddlers is increasingly becoming apparent. However, the lack of trained healthcare personnel and culturally appropriate measures makes it a challenge in low- and middle-income countries. A needs-based assessment of the extent of the problems in toddlers will help address the lacunae in providing mental health services.
A needs-based assessment was carried out of a community sample of 9,287 mothers with toddlers aged between 13 and 25 months in Kerala, India. This assessment was conducted by junior public health nurses using an indigenously developed checklist titled \'Screening checklist for Behavioural, Emotional and Rhythm-related disturbances in Toddlers\' (S-BERT).
According to the mothers surveyed, 30.4% of toddlers had concerning or distress causing behaviours. Three factors, namely behavioural, rhythm-related and emotional disturbances, were deemed significant when the item response theory was used to examine the factor structure of S-BERT.
This study suggests that behaviours that cause distress to mothers of toddlers are common, if queried specifically. Given the constraints in health resources as the cultural factors in operation, use of indigenous tools and principles of collaborative stepped care may be the way forward.
Propósito: La necesidad de mejorar la salud mental en lugares de atención primaria para infantes y niños pequeñitos es cada vez más aparente. Sin embargo, la falta de un personal entrenado de cuidado de salud y medidas culturalmente apropiadas la convierte en un reto en países de bajos y medianos recursos económicos. Una evaluación, con base en las necesidades, de la extensión de los problemas en los niños pequeñitos ayudará a llenar el vacío de proveer servicios de salud mental. Métodos: Una evaluación con base en las necesidades se efectuó en un grupo muestra comunitario de 9,287 madres con niños pequeñitos de edad entre los 13 y 25 meses en Kerala, India. Esta evaluación la llevó a cabo por un grupo de nuevas enfermeras de salud pública usando una lista de verificación desarrollada localmente y conocida como “Lista para verificar la examinación de trastornos en el comportamiento, la emoción y relacionados con el ritmo en niños pequeñitos” (S-BERT). Resultados: De acuerdo con las madres de la encuesta, 30.4% de los niños pequeñitos presentaban preocupaciones o angustias que causaban el comportamiento. Tres factores, a saber, del comportamiento, relacionados con el ritmo y trastornos emocionales, fueron considerados significativos cuando se usó la Teoría de Respuesta a los Asuntos para examinar el factor estructura de S-BERT. Conclusión: Este estudio sugiere que los comportamientos que causan la angustia a las madres de niños pequeñitos son comunes, si se consultan específicamente. Dadas las limitaciones en cuanto a los recursos de salud como los factores culturales operativos, el uso de herramientas locales y principios de cuidados escalonadamente colaborativos pudiera ser el camino a seguir.
But: Le besoin d\'améliorer la santé mentale dans des contextes de soin primaire pour les bébés et les jeunes enfants devient de plus en plus apparent. Cependant le manque de personnel de soin de santé formé et le manque de mesures culturellement appropriées en font un véritable défi dans les pays à revenu faible ou intermédiaire. Une évaluation de l’étendue des problèmes chez les jeunes enfants, basée sur le besoin, aidera à s\'attaquer aux lacunes en offrant des services de santé mentale. Méthodes: Une évaluation basée sur les besoins a été faite chez un échantillon communautaire de 9287 mères avec des petits enfants âgés de 13 à 25 mois à Kerala en Inde. Cette évaluation a été faite par de jeunes infirmières et infirmiers de santé publique utilisant une checklist développée sur place intitulée “Checklist de dépistage de troubles comportementaux, émotionnels et du rythme chez les petits enfants” (S-BERT). Résultats: Selon les mères qui ont été sondées, 30,4 des petits enfants avaient des comportements inquiétants ou des comportements de détresse. Trois facteurs, soit les perturbations comportementales, liées au rythme et émotionnelles, ont été estimées être importants lors que la Théorie Item Response a été utilisée afin d\'examiner la structure de facteur de la S-BERT. Conclusion: Cette étude suggère que les comportements qui causent de la détresse aux mères de petits enfants sont communs, s\'ils se trouvent spécialement dans les questions. Compte tenu des contraintes des ressources de santé en tant que facteurs culturels de l\'opération l\'utilisation d\'outils développés sur place et les principes de soins élaborés de manière collaborative peuvent s\'avérer être la meilleure manière d\'aller vers l\'avant.
Verhaltens-, emotionale und rhythmische Störungen bei Kleinkindern - vorläufige Ergebnisse einer gemeindenahen Studie in Kerala, Indien Ziel: Die Notwendigkeit, psychische Gesundheit in der Grundversorgung von Säuglingen und Kleinkindern zu verbessern, wird immer deutlicher. Aufgrund des Mangels an geschultem Fachpersonal und kulturell angepassten Maßnahmen stellt dies jedoch in Ländern mit niedrigem und mittlerem Einkommen eine Herausforderung dar. Eine am Bedarf orientierte Beurteilung des Ausmaßes der Probleme bei Kleinkindern wird dazu beitragen, die Lücken in der psychischen Gesundheitsversorgung zu schließen. Methoden: In Kerala, Indien, wurde an einer Community-Stichprobe von 9287 Müttern mit Kleinkindern im Alter zwischen 13 und 25 Monaten eine Bedarfsanalyse durchgeführt. Die Beurteilung wurde von Junior-Pflegekräften des öffentlichen Gesundheitswesens unter Verwendung einer eigens entwickelten Checkliste mit dem Titel „Screening-Checkliste für Verhaltens-, emotionale und rhythmische Störungen bei Kleinkindern“ (S-BERT) durchgeführt. Ergebnisse: Laut den befragten Müttern zeigten 30,4% der Kleinkinder besorgniserregende oder belastende Verhaltensweisen. Um die Faktorstruktur von S-BERT zu untersuchen, wurde die Item-Response-Theorie verwendet. Drei Faktoren, nämlich Verhaltens-, Rhythmus- und emotionale Störungen, wurden als signifikant erachtet. Schlussfolgerung: Diese Studie legt nahe, dass von Müttern als belastend erlebte kleinkindliche Verhaltensweisen häufig sind, wenn gezielt danach gefragt wird. Angesichts der eingeschränkten Gesundheitsressourcen und kulturelle Faktoren könnten der Einsatz einheimischer Instrumente und das Prinzip der kollaborativen Stufenpflege eine Lösung sein.
幼児の行動と情緒とリズムに関連する問題 インドのケーララ州 (Kerala) における地域密着研究の先行報告 目的:乳幼児のプライマリーケアにおいて精神保健を強化する必要性がますます 明らかになっている。しかし、訓練された精神保健従事者と文化的適合性の高い 手法の欠如が、中または低所得国での精神保健の充実を困難にしている。ニーズ に基づく幼児の問題の範囲を測定するアセスメントが、精神保健サービス提供の 切れ目への対応に役立つ可能性がある。 方法:インド、ケーララ州において、生後1歳1か月～2歳1か月の幼児とそのお母 さんの9287組の地域サンプルに対し、ニーズに基づく評価を行った。この評価は、 ｢幼児の行動と情緒とリズムに関連する問題のスクリーニング調査票 (S-BERT) ｣ と名付けた独自に開発された方法を用い、準公衆衛生保健師により実施された。 結果:調査を受けた母親達によると、幼児の30.4％に気になる、もしくは苦痛に 関連する行動があった。項目応答理論を用いてS-BERTの構成項目を検討したとこ ろ、3項目、すなわち、行動の問題、生活リズム関連問題、情緒的な問題が重要 とみなされた。 結論　本研究では、具体的に質問した場合には、幼児の母親に苦痛をもたらす行 動は共通していることが示唆された。運営における文化的要因としての保健資源 の限界を考えると、独自に開発されたツールの使用と協働による段階的医療の方 針によって前進できる可能性がある。.
研究目的:在婴幼儿初级保健机构中加强心理健康的需求日益明显。然而, 由于缺乏训练有素的保健人员以及文化上的适当措施, 这在中低收入国家是一个挑战。对幼儿问题的严重程度进行基于需求的评估将有助于解决提供心理健康服务方面的不足。 研究方法:对印度喀拉拉邦的一个社区样本进行了基于需求的评估, 样本为拥有13-25个月龄幼儿的9287名母亲。这项评估是由初级公共卫生护士使用一份自主开发的题为“幼儿行为、情绪和节律相关障碍筛查清单” (S-BERT) 的检查表进行的。 研究结果:根据受访母亲的调查, 30.4%的幼儿有使其担忧或引起痛苦的行为。运用项目反应理论考察S-BERT的因子结构时, 发现行为、节律相关和情绪障碍三个因素是显著的。 研究结论:这项研究表明, 如果确切询问的话, 给幼儿母亲带来痛苦的行为是常见的。鉴于卫生资源方面的制约来自现行的文化因素, 运用本土工具和协作分级护理原则可能是前进的方向。.
الاضطرابات السلوكية والعاطفية المرتبطة بالإيقاع عند الرضع - نتائج أولية من دراسة مجتمعية في كيرالا، الهند، الغرض من الدراسة: أصبحت الحاجة إلى تعزيز الصحة النفسية في أماكن الرعاية الأولية للرضع والأطفال الصغار واضحة بشكل متزايد. غير أن الافتقار إلى موظفي الرعاية الصحية المدربين والمقاييس الملائمة ثقافياً يجعلان من ذلك تحدياً في البلدان المنخفضة والمتوسطة الدخل. وسيساعد تقييم مدى المشاكل التي تواجه الأطفال الصغار على أساس الاحتياجات في معالجة الثغرات في تقديم خدمات الصحة النفسية. منهج الدراسة: تم إجراء تقييم قائم على الاحتياجات لعينة مجتمعية من 9287 أم مع أطفال صغار تتراوح أعمارهم بين 13-25 شهرا في ولاية كيرالا، الهند. وقد أجرى هذا التقييم ممرضات الصحة العامة المبتدئات باستخدام قائمة مرجعية محلية بعنوان \"قائمة فحص الاضطرابات السلوكية والعاطفية المرتبطة بالإيقاع عند الأطفال الصغار (BERT-S). النتائج: وفقا للأمهات الذين شملهم الاستطلاع، كان 30.4 % من الأطفال الصغار لديهم سلوكيات مقلقة أو مسببة للضيق. وكان هناك ثلاثة عوامل اعتبرت هامة وفقا لنظرية استجابة العنصر: الاضطرابات السلوكية، الاضطرابات المرتبطة بالإيقاع، والاضطرابات العاطفية. الخلاصة: تشير هذه الدراسة إلى أن السلوكيات التي تسبب الضيق لأمهات الرضع شائعة، إذا تم الاستفسار عنها على وجه التحديد. ونظراً للقيود التي تواجه الموارد الصحية وخاصة في ضوء العوامل الثقافية، فإن استخدام الأدوات المحلية ومبادئ الرعاية التعاونية قد تكون هي الوسيلة الأمثل.

This study examines the emotional and behavioural pathways to adolescent substance use and antisocial behaviour. Using a sample of 17,223 participants from the UK Millennium Cohort Study, we applied parallel-process growth mixture modelling on emotional and behavioural symptoms in those aged 3-14 and employed latent class analysis to identify patterns of substance use and antisocial behaviours at age 14. We then performed a multinomial regression analysis to explore the association between emotional and behavioural trajectories and patterns of adolescent substance use and antisocial behaviours, including sociodemographic, family, and maternal factors. We found five trajectories of emotional and behavioural symptoms and four classes of adolescence substance use and antisocial behaviour. Children and adolescents in the \'high externalising and internalising\' and \'moderate externalising\' trajectories were more likely to belong to any problematic behaviour class, especially the \'poly-substance use and antisocial behaviours\' class. Inclusion in the \'moderate externalising and internalising (childhood limited)\' class was associated with higher odds of belonging to the \'alcohol and tobacco\' class. These associations remained significant after adjusting for important sociodemographic and contextual factors, such as maternal substance use, poverty, and parental status. Interventions on adolescent health promotion and risk behaviour prevention need to address the clustering of substance use and antisocial behaviour as well as the significant influence of early and chronic internalising and externalising symptoms on the aetiology of these behaviours.