Regulatory and Educational Initiatives to Prevent Food Choking Injuries in Children: An Overview of the Current Approaches.

Choking injuries are one of the major causes of death among children ages 0-3, and most of these injuries are related to food. This work provides an overview of the current recommendations for food choking prevention and educational targets as a basis for developing a unified common set of knowledge for primary prevention policies development. Guidelines published by professional membership organizations and national governments in the English language were considered. All of these guidelines provide lists of hazardous food items and recommendations for food preparation to minimize choking hazard. Together with recommendations for food preparation, also recommendations aimed at stakeholders (food manufacturers, health care providers, and public authorities) are provided, underlining that this severe public health problem should be further addressed by adopting integrated public health interventions. Our overview stressed the importance of developing educational and primary prevention policies to sensitize adult supervisors and to regulate dangerous food products in the market.

Discursive construction of social representations expressed by seekers of psychosocial healthcare services in Brazil.

BACKGROUND: The current paper discusses the results of a study realized with 66 seekers of 12 psychosocial healthcare services (CAPS) in Brazil, by investigating their social representations. AIMS: Throughout a quali-quantitative approach, unstructured interviews have been conducted and focused on two themes: one related to mental suffering and another to the CAPS itself. METHOD: The data were processed adopting the Iramuteq software for text-mining-analysis. RESULTS: Out of the findings emerged four lexical classes due to the discursive representation of: (1) CAPS (39.7%); (2) social life (29.7%); (3) family (13.6%) and (4) medication and care (17%), where the utterance NÃO (NO) occupies a central position. Accordingly, the NO is associated with 'not there' and 'not here', contrasting the care provided outside the CAPS, represented as inhumane or inadequate, to that provided inside the CAPS, linked to feelings of 'not being discriminated, mistreated and unrecognized'. The underlying social representations expressed in the interviews show an opposition between what was experienced outside and what was experienced inside the CAPS. CONCLUSION: The care received in CAPS units is the expression of a new psychosocial paradigm in a process of implementation, focused on participation and interdisciplinarity, as opposed to the biomedical paradigm focused on the disease.

Monitoring Public Perception of Health Risks in Brazil and Italy: Cross-Cultural Research on the Risk Perception of Choking in Children.

One of the most relevant public health issues among pediatric injuries concerns foreign body (FB) aspiration. The risk perception of choking hazards (CH) and risk perception, in general, are complex multifactorial problems that play a significant role in defining protective behavior. Risk prevention policies should take this aspect into account. A lack of scientific knowledge of FB injury risk perception may be evidenced in Brazil and other newly developed countries. This study aims to characterize the differences and peculiarities in risk perception of CH between Italian and Brazilian populations. The risk perception among adults in Italy and Brazil between September and October 2017 was investigated in a survey. A Multiple Correspondence Analysis was carried out to identify the latent components characterizing the risk perception in Italian and Brazilian population samples. The most relevant dimension characterizing risk perception is the "Professional-educational status and the related perception of Risk" (13% of factorial inertia). The Italians identify batteries and magnets as the most dangerous choking risks (20% of responses). On the other hand, Brazilian people, mainly manual laborers (22%) with secondary or primary education (94%), perceive coins as the most dangerous items (30% of responses, p < 0.001). Socio-economic issues characterize the subjective risk perception of Italian and Brazilian survey respondents. In this framework, data-driven prevention strategies could be helpful to tailor intervention strategies to the cultural context to which they are addressed.

Does Love Really Make Mothers Blind? A Large Transcontinental Study on Mothers' Awareness About Their Children's Weight.

OBJECTIVE: The aim of this study was to assess maternal misperception rates (perception as normal or underweight of a child with overweight or obesity) and their role in affecting the chance of implementing actions to change children's weight. METHODS: Obesogeneicity of Gadgets Marketed with Snacks (OBEY-AD) is an international study investigating factors promoting childhood overweight and obesity in 10 countries, in which 2,720 child-mother dyads have been enrolled. Mothers' perception of their children's weight was assessed using a projective test. Children's weight status was measured according to the anthropometric standards established by the World Health Organization. RESULTS: Mothers classified 89% of children with overweight and 52% of children with obesity as normal weight. The odds ratio of mothers' misperception was significantly higher for higher parental BMI, higher children's International Brand Awareness Inventory score, and high family socioeconomic status. Children with overweight and/or obesity who were perceived as normal weight by their mothers were less likely to be referred to specific health care services. CONCLUSIONS: Most children with overweight and/or obesity were perceived as normal weight by their mothers. Such lack of concern regarding a severe disease might interfere with the effectiveness of prevention programs. Considering the contextual factors that frame the etiological causes of a disease may help in finding effective and enduring solutions to target childhood obesity.

Obese children are thin in parents' eyes: A psychologically, socially, or culturally driven bias?

Although obesity presents a serious health problem in children, parents often underestimate their children's overweight and obesity status. Therefore, scientific literature was systematically screened through PubMed and PsycINFO to demonstrate the psychological, social, and cultural processes that underlie this evaluation bias. A total of 37 papers that focused on research conducted in different geopolitical contexts were taken into account. Furthermore, a lexicometric analysis of the papers' conclusions was performed. The findings showed that education plays a key role in promoting parents' awareness and their realistic recognition of their children's weight. Accordingly, adequate educational support for parents should be implemented in all healthcare policies addressing childhood obesity.

Is branding food promoting obesity? An investigation on children in San Luis Potosí

This study aims at assessing children's awareness towards branded food products in central Mexico. One-hundred and twenty children, aged 3-10 years and balanced by gender, were recruited in San Luis Potosí. Kids' heights and weights were measured in order to calculate their BMI. A cross-sectional questionnaire was administered to children's parents in order to gain socio-demographic information. Children's brand awareness was assessed using the IBAI (International Brand Awareness Inventory). Basic exploratory analyses were performed for samples' general characteristics, and ANOVA was adopted for investigating differences between the IBAI tasks. Results demonstrated that 50% of kids correctly associated the logo to the respective brand in more than 70% of the cases. About half of the sample recalled the right name of the food type in 50% of the cases. 50% of kids recognized the brand name in less than 20% of cases. Older children (7-10 y) showed a higher brand awareness when compared to younger ones (3-6 y). Children demonstrated a consistent knowledge of famous fast-food and snack products. Prevention through informative campaigns should make parents more aware of the TV contents, their kids are exposed to(AU)

Este estudio tiene como objetivo evaluar la conciencia de los niños hacia los productos alimenticios de marca en México. Ciento veinte niños, de entre 3-10 años en grupos equitativos por sexos, fueron reclutados en San Luis Potosí. Se midieron la talla y los pesos de los niños con el fin de calcular sus IMC. A los padres de los niños se les entrego un cuestionario transversal a fines de obtener información socio-demográfica. El conocimiento de la marca de los niños se evaluó, mediante el uso del IBAI (Inventario Internacional de conocimiento de la marca). Se realizó un análisis exploratorio de base para obtener las características generales de la muestra y se adoptó un anova para investigar las diferencias entre las tareas ibai . Los resultados demostraron que el 50% de los niños había asociado correctamente el logotipo de la marca respectiva en más del 70% de los casos. Aproximadamente la mitad de la muestra recordaba el nombre correcto de marca de alimentos en el 50% de los casos. 50% de los niños reconocía el nombre de la marca en menos del 20% de los casos. Los niños mayores (7-10 años) mostraron una conciencia de marca más alta si se compara con los más jóvenes (3-6 años). Los niños demostraron consistentemente tener conocimiento de los productos de comida rápida y bocadillos más conocidos. La prevención a través de campañas informativas debería conscientizar a los padres sobre los contenidos de televisión a los que que sus hijos están expuestos(AU)

Food advertising on TV and energy intake in children: results from the OBEY-AD Mexico

Food advertising on TV is a common marketing practice, and it is suspected of promoting obesogenic behaviours. The study aimed at evaluating if gadgets (toys) packaged with food increase food consumption, and if contemporary exposure to TV and/or advertising is a further promoting factor. Onehundred and twenty children (balanced according to gender and age groups, 3-6 and 7-10 years old) were randomised in an experimental setting designed as a 2x5 full factorial ad libitum eating study. The first factor was represented by the exposure to gadgets, organized on two levels, "food with gadget" (TOY) and "food alone" (NoTOY). The second one consisted in the exposure to TV and advertising along five levels (no exposure to TV, exposure to TV without advertising, exposure to TV and 1, 2, or 3 advertsements). Our results showed no significant differences when considering the groups even after taking into account the dependent variables. The medium spot group showed the lowest energy intake, but the difference between the other groups was not significant. TV advertising and the presence of gadgets (toys) do not influence caloric intake in children(AU)

La publicidad de alimentos en la televisión es una práctica común de comercialización, y se cree que puede promover comportamientos obesogénicos. El estudio tiene como objetivo evaluar si los gadgets (juguetes) empaquetados con alimentos aumentan el consumo de alimentos y si la exposición contemporánea a la televisión y / o la publicidad es un factor promotor adicional. Ciento veinte niños (agrupados por sexo y edad, 3-6 y 7-10 años de edad) fueron asignados al azar en una escuela de San Luis Potosí -México. Los niños fueron asignados al azar en el contexto experimental de un estudio de diseño factorial completo 2x5 de consumo de alimentos ad libitum. El primer factor estuvo representado por la exposición a juguetes y estuvo organizado en dos niveles: "alimento con juguetes" (TOY) y "alimento solo" (NoTOY). El segundo consistía en la exposición a la televisión y a publicidad televisiva a lo largo de cinco niveles (sin exposición a TV, exposición a TV sin publicidad, exposición a TV y a 1, 2 o 3 anuncios publicitarios). Nuestros resultados no mostraron diferencias significativas entre los grupos, incluso teniendo en cuenta las variables dependientes. Sólo en el grupo mediano al que se mostraron dos publicidades se observó el consumo de energía más bajo. La diferencia entre los otros grupos no fue significativa(AU)

Narratives of Transgender People Detained in Prison: The Role Played by the Utterances "Not" (as a Feeling of Hetero- and Auto-rejection) and "Exist" (as a Feeling of Hetero- and Auto-acceptance) for the Construction of a Discursive Self. A Suggestion of Goals and Strategies for Psychological Counseling.

Purpose: Understanding how transgender people, who committed criminal offenses and are detained in prison, produce a narrative representation of self within different prison contexts. More specifically, this study has been based on two sub-aims: On a paradigmatic level, it has been aimed at critically investigating how the discursive positioning among the Self and the Other might promote the internalization of positive and/or negative attitudes toward the self. On a pragmatic level, it intends to offer some suggestions for goals and strategies of psychological counseling with these inmates inside such highly institutionalized contexts. Method and Materials: In total, 23 in-depth interviews were conducted with transgender women detained in either female or male prison contexts in Italy and Brazil. The lexical, semantic, and semiotic structure of the transcribed interviews has been investigated by adopting the quali-quantitative software Iramuteq for performing statistical text-mining analysis. Frequency, correspondences, and distribution of the most representative utterances across the corpus of data have been accessed and critically analyzed. Results: The findings showed that transgender inmates in Brazil made repeated use of the adverb "not," while the verb "exist" became the most representative word for the Italian sample. In Brazil, indeed, transgender women assumed masculine-driven behavior due to a common imprisonment with cis-gender men. On the contrary, transgender women in Italy are detained in protected sections, where they are allowed to wear female clothing and continue hormonal treatments. Surprisingly, transgender inmates in Italy suffered more violence in a female sector when compared to exclusively male jails. Conclusions: Transgender people represent a challenge for prison administration because it is not clear in which penitentiary context they should be detained. They should receive special attentions in order to face their special needs, which are radically different when compared to other typologies of inmates. Within penitentiary contexts, psychological counseling with transgender women should pay a special attention to the several psycho-social dimensions of this existential condition. In particular, psychological counselors should consider its inner complex articulation within different social, cultural and normative contexts.

Is Internet use associated with anxiety in patients with and at risk for cardiomyopathy?

OBJECTIVE: The aim of the study was to determine the relation between online health information seeking behavior and anxiety level among a sample of patients with manifested cardiomyopathy or at risk for cardiomyopathy. METHODS: The research is a cross-sectional study conducted among 104 patients with cardiomyopathy diagnosis and patients at risk for cardiomyopathy. Patients completed 3 different questionnaires: Use of Internet Health Information questionnaire about the use of Internet, Short Form SF-12 items questionnaire on quality of life, and State-Trait Anxiety Inventory measuring general anxiety levels. RESULTS: Forty-eight patients had a diagnosis of primary or secondary cardiomyopathy, and 56 patients, with conditions predisposing to cardiomyopathy. Eighty-five percent of the considered population is surfing the Internet to obtain nonspecific information about health in general, and the 65% use it to look specifically for heart disease. For both groups of patients with cardiomyopathy and at risk for cardiomyopathy, online health information seeking behavior is associated with substantially lower state anxiety levels (P = .041). CONCLUSION: Web use, as a source of health information, has been shown to be associated with anxiety reduction in patients with or at risk for cardiomyopathy, suggesting that Internet technology can be a useful instrument due to its informational power and its potentially therapeutic value.

Cross-regional analysis of multiple factors associated with childhood obesity in India: a national or local challenge?

OBJECTIVE: To investigate obesogenic co-causing factors, promoting rise of weight in children, associated to local differences in India. METHODS: Overall 1,680 children, aged 3-11 and balanced by gender, were recruited in school contexts distributed in seven major Indian cities. All children were weighted and measured in order to calculate their BMI. A validated cultural specific questionnaire was administered to children's parents for assessing socio-demographic data, eating habits, physical activity, etc. Furthermore children's brand awareness scores were computed in order to analyze their affiliation towards food-based advertisement. Descriptive statistics of frequencies, duration and intensity of the various factors were performed. Chi-square tests or Wilcoxon signed rank test were used for evaluating significance of differences in factors distribution across Indian cities. RESULTS: Four factors, promoting rise of children's weight, were individuated as associated to urban differences, namely meal times consumed in the family, parents' BMI, brand awareness and physical activity. These aspects exercised a significant impact on children's body size in Kolkata and Chennai. Hyderabad and Mumbai, instead, were the cities where religion played some role in influencing children's weight gain. CONCLUSIONS: Such findings underline the need to frame obesity as a situated phenomenon rather than a national problem. Health policies, implemented in treating and preventing obesity, should be therefore specifically focused on locally situated peculiarities.

Physical activity patterns among school children in India.

OBJECTIVE: To assess the prevalence of physical activity and its relation with socio-demographic variables and eating habits among school-aged children in India. METHODS: The study incorporated secondary analysis of anthropometric measurements and questionnaires on lifestyle and dietary habits of 1,680 school children aged between 3 and 11 y, obtained while carrying out the OBEY-AD project. The inventory contained questions about several variables concerning to physical activity, educational background, lifestyles and eating habits for both children and parents. Questions were organized along specific contents, which could be informative topics, picture choices and multiple answers choices. RESULTS: Prevalence of inactivity was 21% and exhibited significant variations between cities. Physical activity was significantly associated to socio-economic status and consumption of fruits and vegetables. No association could be revealed with children's BMI. CONCLUSIONS: Health-promotion interventions aimed at improving healthy lifestyles in Indian children should focus on population strata with low socio-economic status.

Food packaged with toys: an investigation on potential obesogenic effects in Indian children.

OBJECTIVE: To investigate, in a large pan Indian sample of school children, whether gadgets (toys) added to food increase food consumption, and if contemporary exposure to TV and/or advertising is a further promoting factor. METHODS: A total of 1,680 Indian children were first randomized to food exposure with or without toy and then to a five-level exposure to TV viewing and advertising according to a 2 × 5 full factorial ad libitum eating design study. The sample size was computed to detect a difference of 20 Kcal of caloric intake (assuming the same standard deviation of 20 Kcal in both groups) between "food with gadget" (Toy) and "food alone" (No Toy) groups in each level of the exposure to TV and advertising factor, given an alpha error equal to 0.05 and a power of 0.90. RESULTS: Mean caloric intake both in "Toy" and "No Toy" group was around 223 Kcal. When considering exposure to TV and advertising, mean values varied negligibly between 222 and 225 Kcal. According to linear models for the effect of gadget and exposure to TV and/or advertising on children's intake, no significant adjusted associations were found, neither as main effects nor as interactions. CONCLUSIONS: Food consumption by children is not influenced by the presence of added toys, even after adjustment for several potential confounding factors. The city where they live and age significantly influences Indian children's caloric intake.

Is my kid out of size? Indian mothers' desirability bias in evaluation of their children's weight.

OBJECTIVE: To quantify mothers' social desirability bias with respect to their children's weight in a cross-regional Indian setting. METHODS: The OBEY-AD was a cross-sectional study which has been realized in 7 Indian cities (Bengaluru, Mumbai, Chennai, Hyderabad, Kolkata, New Delhi and Surat), enroling 1,680 children aged 3-11 y of which 50% were females. Children's BMI scores were computed, standardized according to WHO growth charts and categorized as Normal, Overweight, Obese and Underweight. Mothers were asked to judge the weight status of their children through an iconographic test, indicating the shape, which better mirrors the size of their kids. Socio-demographic data, especially employment, income and education, was accessed by administrating a cross-sectional questionnaire to the mothers, involved for the study. RESULTS: Overall, 369 children resulted as obese or overweight (23.5%). Out of them, 75% (278) were not recognized as such by their mothers. Such figures range from up to 76% in Chennai and Surat down to 72% in Hyderabad, Kolkata, New Delhi and Mumbai. Overall agreement between perceived and desired weight status of children was very poor (p < 0.001). Surprisingly, overall 10% of overweight/obese children were considered as even too lean by their mothers. Misperception of children's weight status seemed to be significantly related to urban differences and socio-economic status. CONCLUSIONS: This study quantifies the extent of the so-called social desirability bias, namely mother's unconscious attitude to adapt empirical evidence to more culturally legitimized ideal-types of what their children's weight status is expected to be. Its association with westernized representations of leanness as evaluation criteria for beauty has important policy implications.