Dextrose gel prophylaxis for neonatal hypoglycaemia and neurocognitive function at early school age: a randomised dosage trial

OBJECTIVE

To investigate the effect of different doses of prophylactic dextrose gel on neurocognitive function and health at 6-7 years.

DESIGN

Early school-age follow-up of the pre-hPOD (hypoglycaemia Prevention with Oral Dextrose) study.

SETTING

Schools and communities.

PATIENTS

Children born at ≥35 weeks with ≥1 risk factor for neonatal hypoglycaemia: maternal diabetes, small or large for gestational age, or late preterm.

INTERVENTIONS

Four interventions commencing at 1 hour of age: dextrose gel (40%) 200 mg/kg; 400 mg/kg; 200 mg/kg and 200 mg/kg repeated before three feeds (800 mg/kg); 400 mg/kg and 200 mg/kg before three feeds (1000 mg/kg); compared with equivolume placebo (combined for analysis).

MAIN OUTCOMES MEASURES

Toolbox cognitive and motor batteries, as well as tests of motion perception, numeracy and cardiometabolic health, were used. The primary outcome was neurocognitive impairment, defined as a standard score of more than 1 SD below the age-corrected mean on one or more Toolbox tests.

FINDINGS

Of 392 eligible children, 309 were assessed for the primary outcome. There were no significant differences in the rate of neurocognitive impairment between those randomised to placebo (56%) and dextrose gel (200 mg/kg 46%: adjusted risk difference (aRD)=-14%, 95% CI -35%, 7%; 400 mg/kg 48%: aRD=-7%, 95% CI -27%, 12%; 800 mg/kg 45%: aRD=-14%, 95% CI -36%, 9%; 1000 mg/kg 50%: aRD=-8%, 95% CI -29%, 13%). Children exposed to any dose of dextrose gel (combined), compared with placebo, had a lower risk of motor impairment (3% vs 14%, aRD=-11%, 95% CI -19%, -3%) and higher mean (SD) cognitive scores (106.0 (15.3) vs 101.1 (15.7), adjusted mean difference=5.4, 95% CI 1.8, 8.9).

CONCLUSIONS

Prophylactic neonatal dextrose gel did not alter neurocognitive impairment at early school age but may have motor and cognitive benefits. Further school-age follow-up studies are needed.

Academic Success at Social Costs: An Exploratory Study on Social Networks of Chinese Students under Academic Streaming

In universities that require students to reside in dormitories, there are two types of social networks-study/classroom-based and social/dorm room-based. The academic streaming system may disrupt study/classroom connections, but its impact on students' social networks is unknown. Using self-reported surveys, this study examines ego network measures of network sizes, turnover, multiplexity, and diversity among 382 students (44% female, 56% male). Surveys were administered before and after the university employed a first-semester grade-point average to demote or promote students into an honours college. Follow-up interviews were conducted with 11 honours students staying within their track and 11 students who were re-streamed to the non-honours track. Quantitative results showed that students in the non-honours college and who remained there had increasingly overlapping friendship circles between study and social environments, along with more diverse social connections, indicating stronger networks. In contrast, honours participants experienced fewer overlapping networks across domains and less dispersed social ties, especially after the academic replacement process. Qualitative results showed that the honours students faced a trade-off between academic success and social engagement in maintaining their elite status. Re-streamed students experienced otherness in social groups and decreased psychological wellbeing. This study contributes to the application of network analysis in education and provides insights into the unintended consequences of educational practice on students' social networks.

Stability of executive function in children born at risk of neonatal hypoglycemia

Executive function plays an important role in promoting learning and social-emotional development in children. Neonatal hypoglycemia associates with executive function difficulties at 4.5 years, but little is known about the development of executive function over time in children born at risk of neonatal hypoglycemia. We aimed to describe the stability of executive function from early to mid-childhood in children born at risk of neonatal hypoglycemia and its association with neonatal hypoglycemia. Participants in a prospective cohort study of infants born at risk for neonatal hypoglycemia were assessed at ages 2, 4.5, and 9-10 years. We assessed executive function with batteries of performance-based and questionnaire-based measures, and classified children into one of four stability groups (persistent typical, intermittent typical, intermittent difficulty, and persistent difficulty) based on dichotomized scores (typical versus low at each age). Multinomial logistic regression was used to determine the associations between neonatal hypoglycemia and executive function stability groups. Three hundred and nine children, of whom 197 (64%) experienced neonatal hypoglycemia were assessed. The majority of children had stable and typical performance-based (63%) and questionnaire-based (68%) executive function across all three ages. Around one-third (30-36%) of children had transient difficulties, and only a few (0.3-1.9%) showed persistent difficulties in executive function at all ages. There was no consistent evidence of an association between neonatal hypoglycemia and the stability of executive function. Neonatal hypoglycemia does not appear to predict a specific pattern of development of executive function in children born at risk.

Executive function and behaviour problems in school-age children born at risk of neonatal hypoglycaemia

AIM

To examine the relationship between neonatal hypoglycaemia and specific areas of executive function and behaviour in mid-childhood.

METHOD

Participants in a prospective cohort study of infants born late preterm or at term at risk of neonatal hypoglycaemia were assessed at 9 to 10 years. We assessed executive function using performance-based (Cambridge Neuropsychological Tests Automated Battery) and questionnaire-based (Behavior Rating Inventory of Executive Function) measures and behaviour problems with the Strengths and Difficulties Questionnaire. Data are reported as adjusted odds ratio (aOR) with 95% confidence intervals, and standardized regression coefficients.

RESULTS

We assessed 480 (230 females, 250 males; mean age 9 years 5 months [SD 4 months, range 8 years 8 months-11 years 0 months]) of 587 eligible children (82%). There were no differences in performance-based executive function between children who did and did not experience neonatal hypoglycaemia (blood glucose <2.6 mmoL/L). However, children who experienced hypoglycaemia, especially if severe or recurrent, were at greater risk of parent-reported metacognition difficulties (aOR 2.37-3.71), parent-reported peer (aOR 1.62-1.89) and teacher-reported conduct (aOR 2.14 for severe hypoglycaemia) problems. Both performance- and questionnaire-based executive functions were associated with behaviour problems.

INTERPRETATION

Neonatal hypoglycaemia may be associated with difficulties in specific aspects of parent-reported executive functions and behaviour problems in mid-childhood.

Changes in Chinese students' academic emotions after examinations: Pride in success, shame in failure, and self-loathing in comparison

BACKGROUND

Several attempts have been made to examine students' academic emotions (AEs) in Western contexts, but less is known about how students' self-reported emotions vary over time.

AIMS

The study aimed to understand Chinese students' emotional responses to academic events and the impact of high-stakes testing on their AEs in the first year with a repeated-measures survey after the Semester 1 and Semester 2 mid-term examinations.

SAMPLES

351 first-year university students completed both surveys in an elite Chinese university, where the top 10% of first-year students were assigned to an honours programme.

METHODS

Self-reported AEs survey responses were evaluated with confirmatory factor analysis. Invariance testing between honours and ordinary students and between semesters was used to examine between-group differences across time.

RESULTS

A three-factor model of AEs (i.e., admired, shame, and self-loathing) was found in both semesters, with strong invariance between semesters. Mean scores between groups were equivalent and semester. However, self-loathing had the lowest mean (mean = 2.50; between mostly disagree and slightly agree), admired was at moderately agree (mean = 4.00), and shame was strongest at just over moderately agree (mean = 4.20).

CONCLUSIONS

This study reveals a three-factor structure of AEs and the stability of these emotions among highly successful Chinese learners. Despite being elite students, this sample of Chinese learners felt shame and pride in response to mid-term examinations.

The relationship between subconstructs of empathy and general cognitive ability in the context of policing

Purpose

Empathy has been widely theorized as an important ability in professions such as policing, in which to perform well individuals require multiple and interacting abilities, not least when resolving conflict situations. Even so, there are few studies investigating how subconstructs of empathy relate to other constructs such as general cognitive ability. The purpose of this paper is to establish, after evaluating psychometric properties, relationships among measures of empathy and cognitive ability in a sample of Swedish police students (n = 157).

Design/methodology/approach

Multiple latent variable models of how the different measures work to predict tasks that can be seen as proxies for the ability to understand another person's situation and intentions are evaluated to determine the most robust relationship(s) within the data.

Findings

We find support for the psychometric properties reported in previous studies with the used instruments. We also find support for perspective-taking, a cognitive empathy subconstruct predicting the ability to recognize emotions, and also the affective part of empathy, predicting general cognitive ability. These findings are discussed at length in the paper.

Originality/value

This research adds more knowledge to the issue of how general cognitive ability relates to cognitive empathy and other subconstructs of empathy or Theory of Mind.

Association of Neonatal Hypoglycemia With Academic Performance in Mid-Childhood

IMPORTANCE

Neonatal hypoglycemia is associated with increased risk of poor executive and visual-motor function, but implications for later learning are uncertain.

OBJECTIVE

To test the hypothesis that neonatal hypoglycemia is associated with educational performance at age 9 to 10 years.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study of moderate to late preterm and term infants born at risk of hypoglycemia. Blood and masked interstitial sensor glucose concentrations were measured for up to 7 days. Infants with hypoglycemic episodes (blood glucose concentration <47 mg/dL [2.6 mmol/L]) were treated to maintain a blood glucose concentration of at least 47 mg/dL. Six hundred fourteen infants were recruited at Waikato Hospital, Hamilton, New Zealand, in 2006-2010; 480 were assessed at age 9 to 10 years in 2016-2020.

EXPOSURES

Hypoglycemia was defined as at least 1 hypoglycemic event, representing the sum of nonconcurrent hypoglycemic and interstitial episodes (sensor glucose concentration <47 mg/dL for ≥10 minutes) more than 20 minutes apart.

MAIN OUTCOMES AND MEASURES

The primary outcome was low educational achievement, defined as performing below or well below the normative curriculum level in standardized tests of reading comprehension or mathematics. There were 47 secondary outcomes related to executive function, visual-motor function, psychosocial adaptation, and general health.

RESULTS

Of 587 eligible children (230 [48%] female), 480 (82%) were assessed at a mean age of 9.4 (SD, 0.3) years. Children who were and were not exposed to neonatal hypoglycemia did not significantly differ on rates of low educational achievement (138/304 [47%] vs 82/176 [48%], respectively; adjusted risk difference, -2% [95% CI, -11% to 8%]; adjusted relative risk, 0.95 [95% CI, 0.78-1.15]). Children who were exposed to neonatal hypoglycemia, compared with those not exposed, were significantly less likely to be rated by teachers as being below or well below the curriculum level for reading (68/281 [24%] vs 49/157 [31%], respectively; adjusted risk difference, -9% [95% CI, -17% to -1%]; adjusted relative risk, 0.72 [95% CI, 0.53-0.99; P = .04]). Groups were not significantly different for other secondary end points.

CONCLUSIONS AND RELEVANCE

Among participants at risk of neonatal hypoglycemia who were screened and treated if needed, exposure to neonatal hypoglycemia compared with no such exposure was not significantly associated with lower educational achievement in mid-childhood.

School readiness screening and educational achievement at 9-10 years of age

AIM

To determine whether a multi-domain school readiness screening, the Before School Check (B4SC), identifies children at risk of low educational achievement and to compare the educational outcomes between those referred for intervention and those with B4SC concerns who were not referred.

METHODS

In this longitudinal cohort study of children born at risk of neonatal hypoglycaemia (N 331), the B4SC was performed at 4.5 years of age and a standardised curriculum-based measure of educational achievement was completed at 9-10 years of age. Outcomes of school readiness screening were categorised into 'school readiness concern' or 'no school readiness concern' while 'below standard' and 'well below standard' ratings of educational achievement were combined into a single category of 'low educational achievement'.

RESULTS

Overall, 52% of children had ≥1 school readiness concerns at the B4SC, predominantly about behaviour (46%). Having ≥1 school readiness concern was associated with a nearly twofold increase in the likelihood of low academic achievement (OR 1.85, 95% CI 1.14, 3.02), which was apparent only for behaviour concerns. Of the 128 children with behaviour concerns, only 10 (8%) were referred for further interventions. There was a statistically non-significant increase in the rates of low academic achievement among those referred than those non-referred (60% vs. 47%).

CONCLUSION

Identification of behaviour concerns during B4SC is associated with a moderate increase in the likelihood of low academic achievement at 9-10 years. Further, research is needed to determine how academic achievement can be improved in children with behaviour concerns at school entry.

The contributions of intelligence and executive function to behaviour problems in school-age children born very preterm

AIM

To examine the contributions of specific neurocognitive skills to behaviour problems in children born very preterm.

METHODS

We assessed children born <30 weeks' gestation or <1500 g at age 7 years using subtests of the Wechsler Intelligence Scale for Children Fourth Edition, performance and questionnaire-based measures of executive function, and Child Behavior Checklist and Teacher Rating Form. We evaluated the contributions of IQ and executive function to behaviour problems and the moderating effect of sex using multiple regression.

RESULTS

The 129 children (mean age = 7.2 years) had lower IQ, inferior executive function and increased internalising problems compared with normative samples. Verbal comprehension skills and working memory were associated with total, internalising and externalising problems at school. Performance-based and questionnaire-based executive function were associated with total and externalising behaviour problems both at home and school. Sex moderated the relationships between information processing and parent-reported total problems, and between teacher-rated executive function and total problems.

CONCLUSION

Both IQ and executive function are related to behaviour problems in children born very preterm, but the relationships are different in boys and girls. Executive function may be a useful target for intervention.

Does connectedness to nature improve the eating behaviours of pre-schoolers? Emerging evidence from the Play&Grow randomised controlled trial in Hong Kong

BACKGROUND

Nature-based interventions, which focus on outdoor play, mental health, and self-directed autonomous play, are becoming popular in promoting well-being. The objective of this study was to test whether connecting to nature would contribute to better feeding and eating habits in families with pre-schoolers.

METHODS

241 families with children aged two to five were randomly assigned to the Intervention (IG) and Control Groups (CG). IG received 10 sessions of a family-based programme, which included a novel Connectedness to Nature (CN) element. CG received only the government's health recommendations. The effectiveness of the intervention's primary outcomes (CN, eating/feeding behaviours) was analysed by a repeated measures structural equation model with intervention status as a causal predictor.

RESULTS

204 families (IG, n = 120; CG, n = 84) completed the measurements before and after the trial. The intervention had a medium effect on caregivers' CN (f² = 0.16, (95%CI = 0.06, 0.30)) and a large effect on children's CN (f² = 0.58, (95%CI = 0.36, 0.89)). In the IG, children's CN strongly predicted caregivers' feeding style (β = 0.48 (p < .01, 95%CI = 0.14, 0.83)) and moderately, children's eating behaviours (β = 0.21 (p = .16, 95%CI = -0.09, 0.52)). This produced a positive trend for greater vegetable consumption in the IG compared to the CG (β = 0.20 (95%CI = 0.01, 0.39) vs. β = -0.05, (95%CI = -0.18, 0.08)). Interestingly, the path values in the CG significantly reflected the traditional pattern, (e.g., parental feeding style strongly influenced children's eating behaviour (β = 0.33, p = .001, 95%CI = 0.13, 0.54).

CONCLUSIONS

The Play&Grow intervention positively increased caregivers' and children's CN. It also improved eating behaviors in children independent of their caregivers' feeding style. This may indicate a higher degree of autonomy in children's eating behaviour if they are exposed to nature. Further research should test the CN component in promotion of healthy eating in pre-schoolers.

Relationships between intelligence, executive function and academic achievement in children born very preterm

BACKGROUND

Children born very preterm are at higher risk of adverse neurocognitive and educational outcomes. However, how low intelligence (IQ) and low executive function may each contribute to poorer academic outcomes at school age requires clarification.

AIM

To examine the associations between intelligence, executive function and academic achievement in children born very preterm.

DESIGN/METHODS

This cohort study assessed children born <30 weeks' gestation or <1500 g at age 7 years using the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) for IQ, and the Test of Everyday Attention for Children (TEA-Ch) and Behavior Rating Inventory of Executive Function (BRIEF) for executive function. Academic achievement was rated by teachers against curriculum standards.

RESULTS

Of the 76 children (35 girls, 41 boys, mean age = 7.2 year), 22 (28%) were rated below expected level for reading, 32 (42%) for writing and 38 (50%) for mathematics. After adjustment for sex and socioeconomic status, low IQ (OR's 9.0-12.3) and most low executive function measures (OR's 4.1-9.3) were associated with below-expected achievement. After further adjustment for IQ, low cognitive flexibility (OR = 9.3, 95% CI = 1.2-71.5) and teacher ratings of executive function (OR = 5.3, 95% CI = 1.4-20.2) were associated with below-expected achievement. Mediation analysis showed IQ had indirect effects on writing (b = 1.5, 95% CI = 0.6-3.1) via attentional control; and on reading (b = 1.0, 95% CI = 0.2-3.2) and writing (b = 0.8, 95% CI = 0.1-2.5) via cognitive flexibility.

CONCLUSIONS

Both low IQ and low executive function are associated with below-expected teacher-rated academic achievement in children born very preterm. IQ may influence academic achievement in part through executive function.

Relationships between parenting practices and perceptions of child behaviour among Korean immigrant mothers and fathers

This study examined parenting styles and culturally-specific parenting practices of Korean immigrant mothers (N = 128) and fathers (N = 79) of children (ages 6-10) in New Zealand and the parenting predictors of child behaviour. Participants completed questionnaires on parenting styles and practices, and parental perceptions of child behaviour. Both parents indicated a high degree of devotion (Mo jeong) and involvement in care and education of their child with fathers were more likely than mothers to utilise shaming/love withdrawal and modesty encouragement. Results of regression analyses showed that there were some differences between mothers and fathers in the parenting predictors of child internalising and externalising behaviour problems and prosocial behaviour. Across the whole sample, there were contrasting relationships for authoritative parenting styles, devoted/involved parenting and modesty encouragement/shaming/non-reasoning parenting practices with child behaviour problems. Results indicated a blend of Western and Korean parenting practices were being utilised after settling in New Zealand.

Prospective teachers' conceptions of assessment: a cross-cultural comparison

This paper examines the responses of two sample of prospective teachers (New Zealand, n = 324; and Spain, n = 672) to the Teachers' Conceptions of Assessment inventory (English and Spanish respectively). The inventory captures four major intentions for assessment (i.e., improvement, irrelevance, school and student accountability). The conceptions of prospective teachers about the nature and purpose of assessment are relevant, given that (a) much educational assessment is carried out in classrooms; and (b) prospective teachers enter the teacher education programs with significant prior school experience of assessment as pupils. Results of confirmatory factor analysis indicated that the original model was inadmissible and that the best-fitting revised model was only configurally invariant between the two samples. It would appear that lack of teaching experience results in different responses for prospective teachers to those of practicing teachers. Moreover, differences in societal and cultural priorities for assessment use most likely explain the lack of invariance between samples.

Teachers' conceptions of assessment: validation of an abridged version

Psychometric characteristics of the abridged Teachers' Conceptions of Assessment-III are reported. Data are from a study of 525 New Zealand primary school teachers and from a second study of 692 Queensland primary school teachers. The abridged version of 27 statements using a positively packed response scale had good fit characteristics for primary teachers in both New Zealand (chi(311)2 = 841.02; RMSEA = .057; TLI = .87) and Queensland (chi(311)2 = 1492.61; RMSEA = .074; TLI = .80). While providing information of similar quality to that of the original the abridged version is more efficient than the full scale.

Student information literacy: psychometric validation of a self-efficacy report

Psychometric characteristics of the Student Information Literacy Self-efficacy Report based on responses from 498 students ages 9 to 12 years are reported. Students report their self-efficacy (confidence and difficulty) in 11 different phases of being information literate, i.e., developing a topic, planning, self-management, locating sources, selecting sources, retrieving information, analysing information, evaluating information, synthesising knowledge, presenting knowledge, and self-evaluation using a positively packed rating scale. The data were strongly internally consistent (Cronbach alpha=.95) with a test-retest reliability of .78. The 11 phases, factors measured by a matching pair of self-efficacy questions, were confirmed (chi2=529.68; df= 198; RMSEA =.058; TLI=.940). Ratings were correlated low with teachers' ratings and test scores of information literacy skills and moderately correlated with academic self-concept. The test provides unique information about students' self-efficacy for information literacy. Its use in classrooms is warranted.

Measuring attitude with positively packed self-report ratings: comparison of agreement and frequency scales

Self-report rating scales with balanced response formats, anchored with vague frequency of activity indicators, often elicit inadequate information, especially when respondents are inclined toward a generally positive attitude toward the psychological object being rated. This study used an unbalanced or positively packed rating scale with both frequency and agreement response anchors within the context of a questionnaire about studying and learning practices and conceptions for high school students (N=734). Psychometric characteristics and communication factors were investigated using 12 pairs of items for which both frequency and agreement response formats were used. Communication factors identified by Schwarz in 1999 such as small changes in wording provided adequate explanation for changes in response rate or fit to the IRT measurement model for three pairs of items. Although psychometric evidence of the superiority of agreement over frequency response format was not conclusive, continued use of agreement anchors with a positively packed rating scale appears justified.