Neophobia, sensory experience and child's schemata contribute to food choices.

PURPOSE: The aim of the present review is to analyze dynamic interactions between nutrigenomics, environmental cues, and parental influence, which can all lead to children's neophobic reactions and its persistence in time. METHODS: We reviewed studies available on electronic databases, conducted on children aged from birth to 18 years. We also considered official websites of Italian Institutions, providing advice on healthy eating during infancy. RESULTS: Modern day societies are faced with an eating paradox, which has severe and ever-growing implications for health. In face of a wider availability of healthy foods, individuals instead often choose processed foods high in fat, salt and sugar content. Economic reasons surely influence consumers' access to foods. However, there is mounting evidence that food choices depend on the interplay between social learning and genetic predispositions (e.g., individual eating traits and food schemata). Neophobia, the behavioral avoidance of new foods, represents an interesting trait, which can significantly influence children's food refusal. Early sensory experiences and negative cognitive schemata, in the context of primary caregiver-child interactions, importantly contribute to the priming of children's food rejection. CONCLUSIONS: As neophobia strongly affects consumption of healthy foods, it will be relevant to rule definitively out its role in the genesis of maladaptive food choices and weight status in longitudinal studies tracking to adulthood and, in meanwhile, implement early in life effective social learning strategies, to reduce long-term effects of neophobia on dietary patterns and weight status. LEVEL OF EVIDENCE: Level II, controlled trials without randomization.

Influence of factors commonly known to be associated with health inequalities on antibiotic use in high-income countries: a systematic scoping review.

INTRODUCTION: Inappropriate antibiotic use contributes to antimicrobial resistance. High-income countries have high rates of antibiotic use, with a prevalence of health inequalities amongst populations. OBJECTIVES: To understand the influence of factors commonly known to be associated with health inequalities on antibiotic use in high-income countries. METHODS: Factors commonly known to be associated with health inequalities were defined as protected characteristics under UK's Equality Act (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race/ethnicity, religion or belief, sex, sexual orientation), socioeconomic characteristics (income, insurance, employment status, deprivation, education), geography (urban versus rural, region) and vulnerable groups. The study followed PRISMA-ScR and, PRISMA-E statements. RESULTS: Fifty-eight of 402 identified studies met inclusion criteria. Fifty of those papers (86%) included one or more protected characteristics, 37 (64%) socioeconomic characteristics, 21 (36%) geography and 6 (10%) vulnerable groups. Adults in older age groups, especially those in residential care, had the highest antibiotic use. The influence of race or ethnicity and antibiotic use was particular to country context. Areas of high deprivation had higher antibiotic use compared with areas of no or low deprivation, and geographical variation existed within countries. When faced with health system barriers, migrants relied on alternative routes of antibiotic supply other than prescription. RECOMMENDATIONS FOR FUTURE RESEARCH: To investigate how factors and wider social determinants of health interplay and impact antibiotic use, using frameworks/approaches to reduce health inequalities such as England's Core20PLUS approach. Antimicrobial stewardship initiatives should equip healthcare professionals to review patients at the highest risk of antibiotic use.

A unique approach to the development of infection prevention and control resources for front-line health care workers.

BACKGROUND: Despite successful efforts to reduce Meticillin Resistant Staphylococcus aureus bloodstream infections (BSI) and Clostridium difficile infection, Gram-negative BSI (GNBSI) have continued to increase in England. Public Health England (PHE) and NHS Improvement (NHSI) were tasked by the Minister for Health to lead the development of tools and resources to support healthcare workers to reduce these infections. AIM: To work with commissioners and providers of healthcare to collaboratively develop resources to support whole health economies to reduce GNBSI using a combination of behavioural insights and quality improvement methods. METHODS: We took a unique approach to develop these tools and resources using a combination of behavioural insights, quality improvement and front-line collaboration to ensure the tools and resources were designed around the needs of those who would use them. The approach taken was a stepwise iterative process in two distinct phases: a development phase and a testing phase. Both phases used a combination of behavioural insights, human factors, quality improvement and co-production methods to engage stakeholders in co-designing resources that would support them in their work to reduce GNBSI. FINDINGS: During the development phase, feedback from workshops and stakeholder reviews indicated that tools needed to be reduced, simplified, and communicated clearly. Stakeholders wanted tools that could be used by a cross-system group and indicated that leadership was key to ensuring resources were adopted to drive improvements. The final tools were published on the NHS Improvement GNBSI hub. This electronic platform had 30,000 visits between May 2017 and October 2018.

Giocampus school: a "learning through playing" approach to deliver nutritional education to children.

To improve nutritional knowledge of children, single-group educational interventions with pre/post knowledge assessment were performed in primary schools in Parma, Italy, participating to the Giocampus Program. A total of 8165 children (8-11 years old) of 3rd, 4th and 5th grades of primary school were involved in 3 hours per class nutritional lessons, with specifically designed games and activities for each school grade. To evaluate children learning, a questionnaire was administered before and after three months of educational intervention. A total of 16330 questionnaires were analysed. Children nutritional knowledge significantly increased (p< 0.001) in all school grades. The integrated "learning through playing" approach, including the educational figures, tools and games, was successful in improving children's nutritional knowledge. A stable integration of this method in primary school settings could prepare a new generation of citizens, better educated on health-promotion lifestyles.

Eating disorders and psychopathological traits in obese preadolescents and adolescents.

OBJECTIVE: to investigate the presence of eating disorders (ED) and psychopathological traits in obese preadolescents and adolescents compared to normal-weight peers. DESIGN: Overweight/obese patients aged 11 to 14 y and normal-weight peers' data collected by means of self-report questionnaires administered to parents and children. SETTING: Clinical Nutrition Units in the Municipalities of Rome, Naples, Gallipoli and Atri, Italy. SUBJECTS: 376 preadolescents and adolescents. Patients were 187 (93 boys, BMI=27.9±;4.1; 94 girls, BMI=28.1±4.5); normal-weight controls were 189 subjects (94 boys, BMI=19.4±1.4; 95 girls, BMI=19.5±1.5). MEASURES OF OUTCOME: eating disorder behaviors, psychopathological traits and symptoms estimated by means of the eating disorders scales (EDI-2) and psychopathological scales (CBCL 4-18). RESULTS: Patients reached higher scores than controls in most of the eating disorders scales and psychopathological scales. Twenty-one (11.2%) patients were considered at risk of developing an eating disorder and 75 (40%) presented social problems. With regard to weight status, age-group and gender, main significant interaction effects were seen in social problems (F= 6.50; p<0.05) and ineffectiveness (F= 4.15; p<0.05). CONCLUSIONS: Findings from our study demonstrate that in preadolescence and adolescence, obesity is significantly associated to some traits typical of ED and to psychological problems in general. Although no inference can be made with regard to direction of causality, it is possible to conclude that overweight preadolescents and adolescents can be prone to display problematic traits more commonly associated to eating disorders and to present a high degree of mental distress.

Cross-sectional exploration of maternal reports of food neophobia and pickiness in preschooler-mother dyads.

OBJECTIVE: To investigate cross-sectional associations of food neophobia and pickiness in preschoolers and in their mothers with regard also to food consumption, proposal of new foods, feeding, and weaning modes. DESIGN: Matched child and maternal data collected by means of self-report questionnaires administered to mothers. SETTING: Kindergartens of the City of Rome Municipality, Italy. SUBJECTS: One hundred twenty-seven mother-child pairs. Children were aged from 2 to 6 years. All participants were normal weight or obese. MEASURES OF OUTCOME: Mothers' and children's food neophobia and pickiness. RESULTS: Pickiness and neophobia were related within both children's (r(o) = 0.528, p = 0.001) and mothers' (r(o) = 0.186, p = 0.037) samples. Mothers' and children's neophobia and pickiness were significantly although modestly associated (neophobia r(o) = 0.223, p = 0.012; pickiness r(o) = 0.311, p = 0.001). Overweight and obese children were significantly more neophobic (18.8 ± 6.4 vs 15.7 ± 7.6; p = 0.03) and picky (6.87 ± 2.2 vs 5.72 ± 2.7; p = 0.03) than normal-weight children. CONCLUSIONS: Preschoolers' food neophobia and pickiness were correlated. Mothers and children displayed similarities in food neophobia, pickiness, and dietary habits. Genetics and environmental cues jointly contribute to shape preschoolers' attitudes toward familiar and unfamiliar foods. Hence, future longitudinal studies of larger samples are necessary to better define the role of genetics, parental feeding practices, and environmental characteristics in the development of food neophobia and pickiness.

Differences between ethnic minority and native children in breakfast habits.

Aim of this study was to investigate the breakfast habits in a cohort of school ethnic minority (EM) children admitted to a summer sport school (SSS) in order to evaluate the possible differences with their Italian peers (IP). One hundred-seventy-nine children aged 6-14 years were interviewed through a questionnaire about breakfast behaviors and nutrition habits. The results were compared with those obtained in a randomized sample of 179 Italian peers (IP) attending the same SSS. EM children skip breakfast more frequently than IP (15% vs 7%; p = 0.029). The omissions are attributed to the lack of time (45% vs 54%) and not being hungry upon waking (44% vs 38%). During weekends the percentage of breakfast skippers decreased of about 3 percentage points but persisted a significant difference between the two groups (p = 0.024). EM children who did not have breakfast show a mean BMI higher than breakfast consumers (p = 0.05). Bakery products and milk were the most frequently consumed food and drink in EM and IP children (68% vs 70% and 71% vs 76% respectively). EM children chose and prepared personally breakfast at home more frequently than IP (54% vs 22%). These EM children were more inclined to skip breakfast (p = 0.025) and to have an elevated BMI (p = 0.006) than IP. An educational program, for ethnic minority families, in different languages and according to their cultural, religious and socio-economic influences could be a possible means for changing their lifestyle and reducing their risk to become overweight.