The effect of vitamin B12 supplementation during pregnancy on infant growth and development in Nepal: a community-based, double-blind, randomised, placebo-controlled trial.

BACKGROUND: Vitamin B12 is required for healthy infant growth and development, but low and marginal vitamin B12 status is endemic in low-income and middle-income countries. We aimed to measure the effect of vitamin B12 supplementation from early pregnancy until 6 months post partum on infant growth and neurodevelopment. METHODS: In this community-based, double-blind, placebo-controlled trial, we randomly assigned (1:1) 800 pregnant women (aged 20-40 years) who were up to 15 weeks pregnant-recruited from home visits and outpatient departments at three hospitals in Nepal-to daily supplementation with 50 µg oral vitamin B12 or placebo until 6 months postpartum. Independent scientists generated the list that linked allocation to participants' study identification number. Participants were masked to group assignment and all investigators were masked until data cleaning was completed. The primary outcomes were length-for-age Z score (LAZ) at age 12 months and the cognitive composite score of the Bayley Scales of Infant and Toddler Development (3rd edition) at age 6 months and 12 months. The primary and secondary outcomes, including adverse events, were assessed in the intention-to-treat population, for all participants with available outcome data. This trial is registered with ClinicalTrials.gov, NCT03071666. FINDINGS: 800 eligible pregnant women were enrolled in the trial between March 28, 2017, and Oct 15, 2020, with 400 women randomly assigned to each group. Follow-up was completed on May 18, 2022. At baseline, 569 (71%) of 800 women had plasma vitamin B12 indicating low or marginal status (<221 pmol/L). We found no effect of vitamin B12 on the primary outcomes. The mean LAZ at age 12 months were -0·57 (SD 1·03) in the B12 group and -0·55 (1.03) in the placebo group (366 infants in the vitamin B12 group vs 363 infants in the placebo group) with a mean difference of -0·02 (95% CI -0·16 to 0·13). The mean cognitive composite scores were 97·7 (SD 10·5) in the B12 group and 97·1 (10·2) in the placebo group, with a mean difference of 0·5 (95% CI -0·6 to 1·7) measured in 364 and 361 infants. Stillbirths or infant deaths occurred in three (1%) of 374 women in the vitamin B12 group and nine (2%) of 379 women in the placebo group. INTERPRETATION: Although vitamin B12 deficiency was prevalent in our study population and vitamin B12 supplementation from early pregnancy substantially improved vitamin B12 status, supplementation did not improve infant growth or neurodevelopment. Our findings support the current WHO recommendations of no routine vitamin B12 supplementation during pregnancy. FUNDING: Research Council of Norway.

Parental unemployment and educational outcomes in late adolescence: the importance of family cohesion, parental education, and family income in a Norwegian study.

AIMS: The study aimed to investigate the association between parental unemployment and grade point average and school completion in adolescence, and the importance of family cohesion, parental education, and family income in explaining these associations. METHODS: Data stem from the Norwegian cross-sectional 2012 youth@hordaland-survey including 8437 adolescents (53.4% girls). Information on grade point average, school completion, parental education, and family income were retrieved from the National Education Database. Parental work status and family cohesion were assessed by adolescent self-report. RESULTS: Adolescents with at least one unemployed parent had lower grade point averages (3.49 compared with 3.92, P<0.001) and rates of school completion (71.9% compared with 86.6%, P<0.001) compared with adolescents with two working parents. The associations between parental unemployment and both grade point average (b = -0.22, 95% confidence interval -0.32, -0.12) and school completion (odds ratio 0.59, 95% confidence interval 0.46, 0.76) partly attenuated but remained significant when taking family cohesion, parental education, and family income into account. There was a significant interaction between parental unemployment and family cohesion on grade point average, in which the positive association between family cohesion and grade point average was weaker for adolescents with unemployed parents. CONCLUSIONS: Adolescents with parents outside of the workforce are at higher risk of poorer educational outcomes than peers with working parents. Combined with the positive associations between parental education, family cohesion, family income, and educational outcomes, this underscores the importance of parents for adolescent educational outcomes, and suggests that parents and the family situation should be considered when providing academic support for adolescents who struggle in upper secondary school.

Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence.

Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents and associated with an increased risk of psychiatric diagnoses. This study aimed to ascertain how the number of PTEs differed across adolescent psychiatric diagnoses. Data on PTE exposure were derived from the youth@hordaland survey, and Axis 1 data were from the linked Norwegian National Patient Registry (NPR). Among 10,257 total adolescents, 9,555 (age range: 16-19 years, 53.9% female) consented to register linkage, 8,845 of whom were included in the analyses. Having contact with Child and Adolescent Mental Health Services (CAMHS) predicted more PTEs (estimated marginal mean [EMM] = 1.04, SE = 0.05) and exposure to two or more PTEs compared to having no CAMHS contact (EMM = 0.60) after adjusting for age, ethnicity, sex, and parental education. Adolescents diagnosed with attention-deficit/hyperactivity disorder, depression, trauma-related disorders, conduct disorder, and anxiety experienced significantly more PTEs (EMMs = 0.90-1.63) than those with no CAMHS contact (EMM = 0.57, SE = 0.01). All diagnostic categories except psychosis, autism spectrum disorders, and eating disorders had a significantly higher rate of PTEs compared with adolescents with no CAMHS contact. The study highlights the potential role of exposure to multiple PTEs as a transdiagnostic risk factor, although the level of risk varies between diagnoses.

Social withdrawal behaviour in Nepalese infants and the relationship with future neurodevelopment; a longitudinal cohort study.

BACKGROUND: Social withdrawal in infants may be a signal of distress and a precursor for non-optimal development. OBJECTIVE: To examine the relationship between infant social withdrawal and neurodevelopment up to 4 years in Nepalese children. METHODS: A total of 597 Nepalese infants 6-11 months old were assessed with the modified Alarm Distress Baby Scale (m-ADBB), and of these, 527 with the Bayley Scales of Infant and Toddler Development 3rd edition (Bayley-III) during early childhood, and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) and NEPSY-II subtests at 4 years. We examined whether social withdrawal defined by the m-ADBB was associated with neurodevelopmental scores in regression models. RESULTS: Children socially withdrawn in infancy had lower Bayley-III language scores (-2.6 (95% CI -4.5, -0.7)) in early childhood. This association seems to be driven by the expressive communication subscale (-0.7 (95% CI -1.0, -0.3)), but not the receptive communication subscale (-0.2 (95% CI -0.6, 0.1)). There were no differences in the other Bayley-III scores or the WPPSI-IV and NEPSY-II scores at 4 years in children who were socially withdrawn or not. CONCLUSION: Social withdrawal in infancy was reflected in early language development but not cognitive functioning at 4 years.

Developmental trajectories of conduct problems and time-varying peer problems: the Bergen child study.

BACKGROUND: While it is increasingly acknowledged that conduct problems and peer problems often co-occur in development, less is known about the ways in which peer problems may alter the developmental course of conduct problems for distinct subgroups. METHODS: Using data from a large population-based study in Norway (the Bergen Child Study/youth@hordaland; 47.4% males), we estimated group-based trajectories of conduct problems and the presence of time-varying peer problems on the developmental progression of conduct problems between seven and 19 years of age. Risk factors for group membership were also examined. RESULTS: A 3-group model of conduct problems best fit the data (non-engagers, low-engagers, moderate-stable). The presence of peer problems increased the estimated level of conduct problems for both the low-engagers and moderate-stable groups across adolescence. No differences in conduct problems were observed when peer problems were present in childhood or preadolescence for these two groups, nor for the non-engagers group at any point. Being male, having lower perceived economic wellbeing, and lower levels of parental education predicted group membership for the moderate-stable group, whilst lower paternal education predicted membership for the low-engagers group. CONCLUSIONS: Support for developmental 'turning points' was found, suggesting that adolescence is a particularly salient time for those with conduct problems. In particular, the presence of peer problems can increase observed conduct problems at this stage in development.

Mental health problems and suicidal behavior from adolescence to young adulthood in college: linking two population-based studies.

It is well established that mental health problems are highly recurrent and persistent from childhood to adolescence, but less is known to what extent mental health problems also persist from adolescence into young adulthood. The aim of the current study was therefore to examine the chronicity and risk of mental health problems and suicidality from adolescence to young adulthood. Data stem from two Norwegian population-based studies conducted 6 years apart; the youth@hordaland study from 2012 (age 16-19) and the SHoT2018 study (age 22-25). These two data sources were linked to produce a longitudinal sample of 1257 individuals. A wide range of self-reported mental health and suicidality instruments (used both continuously and categorically) were analyzed using log-link binomial regression analysis, adjusting for age, sex, parental education, and financial problems. We found that high levels of mental health problems in late adolescence were a significant risk factor for reporting poor mental health 6 years later. Internalizing and externalizing problems in adolescence were associated with a 2.8-fold and 1.9-fold increased risk, respectively, of reporting a mental disorder 6 years later. Similarly, self-harm in adolescence was associated with a 2.1-fold increased risk of suicidal thoughts 6 years later. The magnitudes of the adjusted risk ratios were generally similar across the various mental health and suicidality measures used at the two assessment points. Adjustment for confounders did not, or only slightly, attenuate the risk ratios, and all associations remained statistically significant in the adjusted analyses. This longitudinal study provides new evidence of the chronicity of mental health problems and suicidality from adolescence to adulthood in Norway. The results emphasize the importance of early identification and timely interventions to reduce the prevalence and impact of mental health problems and suicidality.

Associations Between Distinct Trauma Classes and Mental Health Care Utilization in Norwegian Adolescents: A National Registry Study.

Adolescents who experience potentially traumatic experiences (PTEs) have an increased risk of psychopathology. PTEs often co-occur and may form interrelated patterns of exposure. This study investigated underlying classes of PTE exposure among Norwegian adolescent participants in the youth@hordaland study, and whether such classes were associated with contact with child and adolescent mental health services (CAMHS) and psychiatric diagnoses. The data stem from the population-based youth@hordaland study conducted in 2012 which was linked to the Norwegian Patient Registry (NPR, n = 8845). Exposure to PTEs was assessed by adolescent self-report whereas psychiatric disorders (Axis 1) were derived from the NPR. Latent Class Analysis was used to identify distinct classes of PTE exposure-patterns in the data. Logistic regression analyses were performed to investigate associations between classes of PTEs and contact with CAMHS and psychiatric diagnoses. Three classes of PTE exposure were identified based on model fit indices and theoretical considerations. Compared with participants in the low trauma class (88% of participants), those in the Situational-(6%) and Interpersonal trauma class (6%) had higher odds-ratios (ORs) for contact with CAMHS (OR = 2.27 (95% CI [1.78, 2.87])) and (OR = 3.26 (95% CI [2.61, 4.04])) respectively, and for being diagnosed with a psychiatric disorder in CAMHS (ORs ranged from 2.19 - 10.4) after adjusting for sex and parental education. There were more participants diagnosed with ADHD within the Interpersonal trauma class compared to the Situational trauma class when adjusting for sex and parental education (OR = 2.22 (95% CI [1.17, 4.40])). Three relatively homogeneous PTE classes, consisting of distinct patterns of trauma exposure were associated with a higher odds of contact with CAMHS and of being diagnosed with a psychiatric disorder in CAMHS. The study highlights the co-occurrence of PTEs and their impact across the diagnostic spectrum.

Sleep and childhood maltreatment: A matched-control study of sleep characteristics in Norwegian 16-19-year-olds.

Sleep problems are an important but understudied health problem in adolescents exposed to childhood maltreatment. The current study aimed to examine sleep characteristics and insomnia in a population with maltreatment history and compare them to a general population sample of adolescents. Data from a sample of Norwegian 16-19-year-old adolescents with childhood maltreatment experiences (n = 62) were linked to an age- and sex-matched general population sample (n = 238). Independent samples t tests were used to compare the two groups on several detailed sleep parameters, while general linear models were used to control for mental health problems, assessed by the Strengths and Difficulties Questionnaire. Mental health was examined as a potential mediator between childhood maltreatment and sleep characteristics. Adolescents exposed to childhood maltreatment had longer sleep onset latency (1:15 h vs. 47 min, p < 0.001), longer wake after sleep onset (34 min vs. 15 min, p < 0.003), lower sleep efficiency in weekdays (77.8%, vs. 85%, p < 0.007), and lower sleep efficiency in weekends (81.8% vs. 88.9%, p < 0.001) than the reference group. Mental health problems fully mediated the association between childhood maltreatment exposure and longer sleep onset latency and wake after sleep onset. The rate of insomnia did not significantly differ between the groups. This study suggests that older adolescents exposed to childhood maltreatment have more sleep problems than the general adolescent population, and that these problems may be explained by co-existing mental health problems. These findings highlight the potential utility of assessing and providing sleep-focused treatment to adolescents with a history of childhood maltreatment and mental health problems.

Later school start time is associated with longer school day sleep duration and less social jetlag among Norwegian high school students: Results from a large-scale, cross-sectional study.

The present study explored the associations between school start time and sleep habits among older adolescents, and whether these associations depended on circadian preference. The sample comprised 4010 high school students aged 16-17 years who completed a web-based survey on habitual school start time, sleep, and health. The survey included the Munich ChronoType Questionnaire, and the short version of the Horne-Östberg Morningness-Eveningness Questionnaire. Students were categorised according to habitual school start time (before 08:00 hours, 08:00 hours, 08:15 hours, 08:30 hours or after 08:30 hours) and circadian preference (morning, intermediate or evening). Data were analysed using two-way analyses of variance (school start time × circadian preference) and linear regression analyses. Results showed an overall effect of school start time on school day sleep duration (main effect, p < 0.001), with the latest school starters having the longest, and the earliest school starters having the shortest sleep duration (7:03 hr versus 6:16 hr; Tukey HSD p < 0.001). Similarly, later school starters generally reported shorter social jetlag and later school day wake-up times than earlier starting students (both main effect p < 0.001). Circadian preference did not modify these associations (interaction effects p > 0.05). In the crude regression analysis, 15 min later school start was associated with 7.2 min more sleep (p < 0.001). School start time remained a significant predictor of school day sleep duration when adjusted for sex, parental educational level and circadian preference (p < 0.001). Results suggest that school start time is a significant predictor of school day sleep duration among adolescents.

Milk-cereal mix supplementation during infancy and impact on neurodevelopmental outcomes at 12 and 24 months of age: a randomised controlled trial in India.

Inadequate protein intake and lack of micronutrients may affect neurodevelopment in infants. This randomised controlled trial was conducted to measure the effect of two milk-cereal mixes with modest and high amounts of protein and enriched with multiple micronutrients, given between 6 and 12 months, on cognitive, language, motor and behavioural scores at 12 and 24 months of age, compared with no-supplementation. The two supplements were also compared with each other. The study was conducted in urban Delhi, India, and the infants were randomised in a 1:1:1 ratio to the three study groups. At 12 and 24 months of age, 1134 and 1214 children were available, respectively. At 12 months of age, compared with no-supplement group, an increase in the motor scores (mean difference, MD 1·52, 95 % CI: 0·28, 2·75) and a decrease in the infant temperament scores (MD - 2·76, 95 % CI: -4·23, -1·29) in the modest-protein group was observed. Those in the high-protein group had lower socio-emotional scores (MD - 1·40, 95 % CI: -2·43, -0·37) and higher scores on Infant Temperament Scale (MD 2·05, 95 % CI: 0·62, 3·48) when compared with modest-protein group. At 24 months, no significant differences in any of the neurodevelopment scores between the three study groups was found. In conclusion, supplementation with modest amount of protein and multiple micronutrients may lead to short-term small improvements in motor function and infant temperament. There appears no advantage of supplementing with high protein, rather negative effects on infant behaviour were observed.

The effect of infant vitamin B12 supplementation on neurodevelopment: a follow-up of a randomised placebo-controlled trial in Nepal.

The most critical period for brain development is before a child's second birthday. Standardised tests measuring neurodevelopment are more reliable when administered after this period. Severe vitamin B12 deficiency affects brain development and function. In a randomised, double-blind, placebo-controlled trial in 600 Nepalese infants (6-11 months at enrolment), we found no effect of 2 µg vitamin B12 daily for a year on neurodevelopment. The primary objective of the current study was to measure the effect of the intervention on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) full scale intelligence quotient (FSIQ). We measured the effect on the Bayley Scales of Infant and Toddler Development 3rd edition at age 30-35 months (n 555). At age 42-47 months (n 533), we used the WPPSI-IV and subtests from the Neuropsychological Assessment, 2nd edition (NEPSY-II). We also used the FSIQ to estimate subgroup specific effects. The mean (sd) WPPSI-IV FSIQ in the vitamin B12 group was 84·4 (8·4) and 85·0 (8·6) in the placebo group (mean difference -0·5 (95 % CI -1·97, 0·94), P = 0·48). There were no effect of the vitamin B12 on any of the other neurodevelopmental outcomes and no beneficial effect in any of the subgroups. In conclusion, providing 2 µg of vitamin B12 for a year in infants at risk of vitamin B12 deficiency does not improve preschool cognitive function.

Parental separation and school dropout in adolescence.

AIMS: To document the association between parental separation and school dropout in adolescence and to examine the factors that may potentially account for this association. METHODS: Data stem from the large youth@hordaland study that was linked to the Norwegian National Educational Database to obtain objective measures of educational outcomes and disposable income (N = 8323). Logistic regression analysis was used to investigate the association between parental separation and school dropout. A Fairlie post-regression decomposition was used to examine the influence of parental education, household income, health complaints, family cohesion, and peer problems in explaining the association between parental separation and school dropout. RESULTS: Parental separation was associated with a higher odds ratio (OR) of school dropout in crude and adjusted (adjusted odds ratio (AOR)) analyses (OR=2.16, 95% confidence interval (CI) =1.90-2.45; AOR = 1.72, 95% CI = 1.50-2.00). About 31% of the higher odds of school dropout among adolescents with separated parents was explained by the covariates. The decomposition analysis suggested that parental education (43%) and disposable income (20%) accounted for most of the explained differences in school dropout. CONCLUSIONS: Adolescents with separated parents are at higher risk for not completing secondary education. Parental education and disposable income accounted for most of the explained differences in school dropout between the groups. Still, the majority of the difference in school dropout remained unaccounted for, indicating that the link between parental separation and school dropout is complex and likely influenced by multiple factors.

The relationship between online communication and adolescents' mental health: Long-term evaluation between genders.

AIMS: In a relatively short time, online communication has become an important part of adolescents' lives, and concerns have been raised about its potential effects on mental health. The first aim was to compare mental health status and online communication in 15-year-old Icelanders born in 1988 and in 1994. The second aim was to assess whether the relationship between online communication and mental health has changed among 15-year-old Icelanders from 2003 to 2015 across genders. METHODS: Analysis used data from self-reports from 2003 (N=385, 51% males) and 2015 (N=302, 42% males). Mental health was assessed with subscales of Symptom Checklist 90 and online communications with self-reports. To evaluate the difference in anxiety and depression, a factorial analysis of variance was conducted between gender and years. Multigroup structural equation modelling was used to assess the change in the relationship between years. RESULTS: Symptoms of anxiety and depression remained unchanged for males. Symptoms of depression increased for females, while anxiety was stable between 2003 and 2015. In 2003, there was no relationship between online communication and mental health. However, in 2015, an association was found for females. CONCLUSIONS: Depression is getting worse for adolescent females, and an association between time spent online communicating and mental health emerged for them in 2015, which did not exist in 2003. These findings add to the possibility that online communication is harmful for mental health, but more detailed studies are still needed.

Mental health among unaccompanied refugee minors after settling in Norway: A matched cross-sectional study.

Aims: To describe the mental health of unaccompanied refugee minors (URMs) settled in Norway and compare their responses to an age- and sex-matched sample of Norwegian young people. Methods: The data were from the Pathways to Independence study of URMs aged 15-20 years (n = 81; 82.7% male; response rate 80%) conducted in 2018-2019 in the Bergen municipality, Norway. The data from the URMs were linked to an age- and sex-matched group of young people from the Norwegian youth@hordaland study conducted in 2012 (n = 324). Mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ). Results: URMs were more likely to agree with most items pertaining to emotional problems, peer problems and prosocial subscales than Norwegian young people. Few differences were found for items on the conduct problems and hyperactivity-inattention problems scales. Poor psychometric properties, including weak factor loadings and low internal consistency, were detected for the SDQ subscales among URMs, except for the emotional problems subscale, indicating that the originally proposed five-factor model fitted the data poorly. Conclusions: URMs appear to have moderately more emotional problems than Norwegian young people. They are more likely to report being alone, getting along better with adults than with their peers and being bullied, but also report being more helpful and sharing with others. Studies with larger samples of URMs should determine the most appropriate factor structure of the SDQ when administered to URM samples.

Parental separation, negative life events and mental health problems in adolescence.

BACKGROUND: Parental separation is associated with mental health problems in adolescence. One suggested pathway for this association is through the accumulated exposure to stress and other negative life events. This study aimed to document the distribution of negative life events among adolescents with separated compared to non-separated parents, and to assess the direct and interactive associations between parental separation, negative life events, and mental health problems in adolescence. METHODS: Data stem from the cross-sectional population-based youth@hordaland study of adolescents (aged 16-19) conducted in Norway in 2012, providing self-reported information about parental separation, negative life events, and depression-, anxiety-, conduct-, and ADHD symptoms. Regression analyses were used to assess the direct and interactive associations between parental separation, negative life events, and mental health problems. RESULTS: Adolescents with separated parents had more mental health problems across all symptom scales compared to peers with non-separated parents, with standardized mean differences [SMDs] ranging from 0.15 to 0.20. Negative life events moderately attenuated these differences (reduced the SMDs with about 0.04-0.08, depending on the outcome). However, none of the interactions between parental separation and negative life events on mental health problems were statistically significant. CONCLUSIONS: Higher exposure to negative life events explains parts of the association between parental separation and mental health problems in adolescence. However, a parental separation does not seem to increase the vulnerability of the effects of negative life events on adolescents' mental health. Assessing exposure to negative life events is important when providing mental health services to adolescents, particularly to those who have parents separated.

Symptoms and antecedents of autism in children born extremely premature: a national population-based study.

The objective of this study is to investigate the prevalence of autism (ASD) symptoms, i.e. , social difficulties, repetitive behaviors, and communicational problems, among children born extremely preterm (EP) compared to a reference group, and to investigate possible antecedents of ASD symptoms among EP children. Method is a national Norwegian cohort of 11 year old EP children, excluding those with intellectual disabilities, non-ambulatory cerebral palsy, blindness, and/or deafness. Parents and teachers reported ASD symptoms using The Autism Spectrum Screening Questionnaire (ASSQ). Social difficulties, repetitive behaviors, communicational problems, and a total ASSQ score were presented. Combined ratings on the ASSQ was defined as parent and/or teacher scoring the child ≥ 98th percentile of the reference group, which was the population-based Bergen Child Study. Of eligible children, 216 (64%) EP and 1882 (61%) reference children participated. EP children had significantly higher mean scores and combined ratings on social difficulties (14.5% vs. 4.1%, OR: 3.2), repetitive behaviors (23.7% vs. 4.0%, OR: 6.4), communicational problems (23.1% vs. 4.8%, OR: 5.4), and the total ASSQ score (18.3% vs. 3.4%, OR: 5.7) compared to reference children. Only no prenatal steroids, IQ 70-84, and mental health problems at 5 years of age were significantly associated with ASD symptoms at 11 years of age. EP children were at increased risk of social difficulties, repetitive behaviors, and communicational problems, and approximately one out of five were reported as high scorers of ASD symptoms. No prenatal steroids use, IQ in the lower range, and mental health problems at 5 years of age were associated with ASD symptoms.

Negative Life Events, Protective Factors, and Substance-Related Problems: A Study of Resilience in Adolescence.

BACKGROUND: There is compelling evidence for an association between negative life events (NLE) and substance-related problems (SRP) during adolescence. The literature is, however, still limited with regards to protective factors for SRP among adolescents exposed to NLE. METHODS: A large population-based survey including 9,611 Norwegian adolescents aged 16 to 19 years, comprised the dataset of this study. The main explanatory variable was NLE. The main outcome variable was SRP, assessed by the CRAFFT scale. Potential protective factors were measured with five subscales from the Resilience Scale for Adolescents (READ) questionnaire. The potential protective factors and sex were explored as moderators for the associations between NLE and SRP. RESULTS: NLE were strongly associated with SRP. Four out of five potential protective factors (i.e., Goal Orientation, Self-confidence, Family Cohesion, and Social Support) showed evidence of a protective-stabilizing effect. Even if they had protective effect across all levels of exposure to NLE, these effects were even stronger for adolescents with high exposure. For Family Cohesion a protective-stabilizing effect was only evident for boys, while a direct protective effect was found for girls. Finally, Social Competence was the only factor that did not show any evidence of promoting resilience toward SRP. CONCLUSIONS: NLE had a strong relation with SRP in this study. Protective factors buffered against SRP for all adolescents - but particularly so for adolescents who had high exposure to NLE. These findings highlight the need for preventive efforts to strengthen protective factors that may promote resilience among adolescents at risk for SRP.

Sleep during COVID-19-related school lockdown, a longitudinal study among high school students.

There has been great concern about the impact of coronavirus disease 2019 (COVID-19)-related school lockdown on adolescent health. The aim of the present study was to compare sleep patterns before and during COVID-19-related school lockdown, in a large sample of high school students. The present study is based a prospective, longitudinal survey on adolescent sleep health. Phase 1 was conducted in 2019, whereas phase 2 was conducted in 2020 (response rate 60.2%), during the last 10 days of a 60-day long school lockdown. Main outcomes comprised sleep parameters from the Munich ChronoType Questionnaire (MCTQ). A total of 2,022 students provided valid responses to MCTQ in both survey phases. Results showed later sleep timing on schooldays in 2020 compared to 2019 (36 min later bedtimes, Cohen's d = 0.56; 1:35 hr later rise times, Cohen's d = 1.44). Time spent in bed on schooldays increased from 8:20 to 9:19 hr (Cohen's d = 0.78), and sleep duration increased by 45 min (Cohen's d = 0.49). The proportion of adolescents obtaining the recommended ≥8 hr of sleep on schooldays increased from 13.4% (2019) to 37.5% during the lockdown. Social jetlag was reduced from 2:37 hr (2019) to 1:53 hr (2020, Cohen's d = 0.59). Results points to a potential advantageous effect of school lockdown in terms of increased school day sleep duration and reduced social jetlag. As sleep is important for mental and somatic health, it is conceivable that increased sleep duration offered some protection against harmful aspects of the COVID-19 pandemic and associated social restrictions. Future studies should address possible associations between sleep changes and health during COVID-19-related school lockdown.

Biomass fuel use for cooking in Nepalese families and child cognitive abilities, results from a community-based study.

BACKGROUND: Biomass fuel use for cooking is widespread in low to middle income countries. Studies on the association between biomass fuel use and cognitive abilities in children are limited. OBJECTIVE: To examine the association between biomass fuel use for cooking and cognitive abilities in Nepalese children at 4 years of age. METHODS: In a cohort design we have information on biomass fuel use in the households of 533 children in infancy and cognitive abilities when they were 4 years old from a community-based sample. Cognitive abilities were measured by the Wechsler Preschool and Primary Scale of Intelligence, 4th edition (WPPSI-IV) and the NEPSY-II. We examined the associations between biomass fuel use and scores on the WPPSI-IV Full-Scale IQ (FSIQ) (primary outcome), and WPPSI index and NEPSY-II subtest scores in multiple linear regression models. The associations were also examined in predefined subgroups. RESULTS: Ninety-nine (18.6%) of the families used biomass fuel for cooking. Children in these families had lower mean FSIQ than children in families with no biomass use (83.3 (95%CI 81.7, 85.0) vs. 85.3 (95%CI 84.5, 86.0)), with a mean difference of -2.2 (95%CI -3.9, -0.5) adjusting for demographics and socio-economic status. The association between biomass fuel use and cognitive abilities was strongest in subgroups of children from households with more than three rooms, with separate kitchen and bedroom, and with higher wealth-score. These interactions were significant for number of rooms in the home (p = 0.04), if the household had separate bedroom and kitchen (p = 0.05), and for the wealth-score (p = 0.03). CONCLUSION: Biomass fuel use for cooking in Nepalese families was associated with lower overall cognitive abilities at 4 years. Uncertainties include exposure misclassification and unmeasured confounding. The associations between biomass fuel use and neurodevelopment in children needs further investigation with more precise measurements of the exposure.

Early child stimulation, linear growth and neurodevelopment in low birth weight infants.

BACKGROUND: Children with low birth weight (LBW) are at risk of linear growth faltering and developmental deficits. Evidence suggests that early child stimulation and care reflected as responsive caregiving and opportunities for learning can promote development. The current analysis aimed to measure the extent to which linear growth and early child stimulation modify each other's association with neurodevelopmental outcomes among LBW infants. METHODS: This is a secondary data analyses from a randomized controlled trial on the effect of community-initiated kangaroo mother care in LBW infants on their neurodevelopment at 12 months of corrected age. Bayley Scales of Infant and Toddler Development was used to assess cognitive, motor and language scores. Stimulation at home was assessed by the Pediatric Review of Children's Environmental Support and Stimulation (PROCESS) tool. PROCESS scores were categorized into three groups: < Mean-1SD (low stimulation); Mean ± 1 SD (moderate stimulation) and > mean + 1SD (high stimulation). RESULTS: A total of 516 infants were available for neurodevelopment assessments. Interactions were observed between length for age z-score (LAZ) and PROCESS score categories. In the low stimulation group, the adjusted regression coefficients for the association between LAZ and cognitive, motor and language scores were substantially higher than in the moderate and high stimulation group. Stimulation was positively associated with neurodevelopmental outcomes in both stunted and non-stunted infants; however, the association was twice as strong in stunted than in non-stunted. CONCLUSION: Moderate to high quality stimulation may alleviate the risk of sub-optimal development in LBW infants with linear growth deficits. CLINICAL TRIAL REGISTRATION: The primary trial whose data are analysed is registered at clinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT02631343 ).