Aim To explore mothers experiences of the EArly Collaborative Intervention. Background Preterm birth puts a considerable emotional and psychological burden on parents and families. Parents to moderate and late premature infants have shorter stays at the neonatal intensive care unit and have described a need for support. The EArly Collaborative Intervention was developed to support parents with preterm infants born between gestational Weeks 30 to 36. In this study, mothers experiences of the new intervention were explored. Design A qualitative design guided by a reflexive thematic analysis according to Braun and Clarke. Interviews were individually performed with 23 mothers experienced with the EArly Collaborative Intervention. Data were identified, analysed and reported using reflexive thematic analysis. The COREQ checklist was used preparing the manuscript. Results Two main overarching themes were constructed. The first theme, mothers feelings evoked from the EArly Collaborative Intervention describes the emotions raised by the intervention and how the intervention affected their parental role. Their awareness of the preterm babys behaviour increased, and the intervention helped the parents to communicate around their babys needs. The second theme, based on the preterm babys behavior, describes experiences of the provision and the learning process about their preterm babys needs and communication. The intervention was experienced as helpful both immediately and for future interaction with the baby. Conclusions Mothers found the intervention to be supportive and encouraging. They came to look upon their baby as an individual, and the new knowledge on how to care and interact with their baby affected both their own and their babys well-being. Furthermore, the intervention felt strengthening for their relationship with the other parent. Relevance to Clinical Practice The EArly Collaborative Intervention can support parents abilities as well as their relation to their baby and may thereby contribute to infant development, cognition and well-being.

This observational cohort study explored objective neurocognitive deficits in COVID-19 patients five months after discharge, and any associations with demographic factors and disease severity indicators. Medical notes of all COVID-19 patients admitted to hospital in Region ostergotland, Sweden, March-May 2020, were reviewed. After applying exclusion criteria, 433 patients were screened by telephone. Of these, 185 patients reported persistent and concerning post-COVID-19 problems, including but not restricted to cognitive functions, and were invited to a clinical evaluation. The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and Colour-Word Interference Test (CWIT) were used to assess immediate memory, visuo-spatial function, language, attention, delayed memory, and executive function. A total of 133 patients had valid test performances. Mean RBANS Global Cognition Score was 83.4, with 37% scoring below cut-off (1.5 SD). Deficits in Attention and Memory indices were most common, each affecting approximately 30% of the patients. After adjustment for sex, language, level of education and premorbid function, neurocognitive performance was positively associated with length of hospital stay, but not with the disease severity indicators WHO CPS and CRP. Findings support that comprehensive neuropsychological assessment should be performed when patients report post-COVID-19 symptoms that affect daily life.

Background This report describes and objectivizes reported problems among a cohort of previously hospitalized COVID-19 patients by clinical examination and determination of the required level of rehabilitation sevices.

Methods This report forms part of the Linkoping COVID-19 Study (LinCoS) that induded 745 individuals from one of 21 Swedish healthcare regions, Region Ostergotland (RO), admitted to hospital for COVID-19 during March 1st-May 31st, 2020. In this descriptive ambidirectional cohort study, all 185 individuals who had reported concerning persisting symptoms were invited to a multi-professional dinical assessment of somatic, functional, affective, neuropsychological status and rehabilitation needs. Rehabilitation needs were assessed using three sub-scales of the Rehabilitation Complexity Scale-Extended.

Findings Among the 158 (85.4%) cases consenting and included in the analysis, we found a broad array of symptoms and signs attributable to COVID-19 involving respiratory, visual, auditory, motor, sensory and cognitive functions that could be confirmed clinically at five months post-discharge. This translated into 16% [95% CI 13-20] of survivors (70/433) of the total regional cohort of hospitalised patients requiring further rehabilitative interventions at follow-up. Weakness in extremities was reported in 28.5% [21.6, 36.2] (45/158). On examination, clinically overt muscle weakness could be corroborated in 15 individuals (10.5%) [6.1, 16.4]. 48% [40, 56] (76/158) reported cognitive symptoms, while the physician noted overt cognitive impairments in only 3% [1.1, 7.5]. In neuropsychological testing, 37% [28-46] (45/122) performed 1.5 SD below the norm, indicating neurocognitive deficits. Fifty-five individuals (34.8%) [27.4, 42.8] reported new or aggravated pain. In three fourths of them, it exerted a moderate or worse detrimental effect on their ability to work.

Interpretation Our study underscores the importance of providing extensive examination of cases with persisting problems after COVID-19, especially since symptoms such as fatigue and breathlessness are highly nonspecific, but may represent significant underlying functional impairments. Robust neurocognitive testing should be performed, as cognitive problems may easily be overlooked during routine medical consultation. In the Swedish context, most rehabilitative interventions could be provided in a primary care setting. A substantial minority of patients should be triaged to specialized rehabilitation services.

Objectives: To identify domains of persisting problems at 4 months after discharge in patients previously hospitalized due to COVID-19, with a focus on a subgroup of patients reporting symptoms to an extent indicative of rehabilitation needs. Design: Ambidirectional observational cohort study. Patients: All patients with a laboratory-confirmed COVID-19 diagnosis admitted to hospital in a Swedish healthcare region during the period 1 March to 31 May 2020. After exclusion, 94% of all survivors (n = 433) participated in the study. Forty-three percent (n = 185) of these reported persisting problems indicating rehabilitation needs and formed a subgroup. Methods: Explorative factor analysis based on results from comprehensive telephone interviews covering persisting symptoms, including assessment of impact on daily life. Results: Seven domains were identified, comprising problems related to vision, cognition, mental fatigue, swallowing, voice, sensorimotor dysfunction, and feeling anxious/depressed. The patients in the subgroup reported a median of 8 symptoms/limitations affecting everyday life, and two-thirds reported symptoms/limitations in 3 or more domains. Conclusion: Seven problem domains corresponding to specific modalities of rehabilitative interventions were identified. A majority of patients reported problems from several domains, indicating the need for multiprofessional teams in post-COVID-19 rehabilitation. Screening of patients previously hospitalized due to COVID-19 should cover all 7 domains of persisting problems.

The study investigates to what degree two different joint media engagement (JME) strategies affect childrens learning from two-dimensional (2D)-media. More specifically, we expected an instructed JME strategy to be more effective than a spontaneous, non-instructed, JME strategy. Thirty-five 2-year old children saw a short video on a tablet demonstrating memory tasks together with a parent. The parents were randomized into two groups: One group (N = 17) was instructed to help their child by describing the actions they saw on the video while the other group (N = 18) received no specific instruction besides "do as you usually do." The parents in the instructed group used significantly more words and verbs when supporting their child but both groups of children did equally well on the memory test. In a second step, we compared the performance of the two JME groups with an opportunistic comparison group (N = 95) tested with half of the memory tasks live and half of the tasks on 2D without any JME support. Results showed that the JME intervention groups received significantly higher recall scores than the no JME 2D comparison group. In contrast, the three-dimensional (3D) comparison group outperformed both JME groups. In sum, our findings suggest that JME as implemented here is more effective in promoting learning than a no JME 2D demonstration but less so than the standard 3D presentation of the tasks.

Moderate to late preterm infants are at risk of developing problems later in life. To support attachment and infants development, high quality parent-infant interaction is important. Parent-infant interaction is known to improve through intervention programs but since no such intervention program is addressed directly to moderate to late preterm infants, a tailor-made intervention was developed. The aim was to describe the rationale, development, framework and practical provision of a new early collaborative intervention program. This study has a descriptive design and the intervention is described using the Template for Intervention Description and Replication. During an intervention-session, the preterm infants cues are made visible to the parents as they perform an everyday care-taking procedure. Instant feedback is delivered to give the parents the opportunity to notice, interpret and respond to cues immediately. The infants response to the parents action is discussed in a dialogue to instantly guide parents awareness of the preterm infants subtle cues. This study describes a new early collaborative intervention, developed to support interaction between parents and their moderate to late preterm infants starting in the neonatal intensive care unit. Clinical studies evaluating parental experiences as well as the effects of the early intervention are ongoing, ClinicalTrials.gov NCT02034617.

Objectives To report findings on brain MRI and neurocognitive function, as well as persisting fatigue at long-term follow-up after COVID-19 hospitalisation in patients identified as high risk for affection of the central nervous system. Design Ambidirectional observational cohort study. Setting All 734 patients from a regional population in Sweden with a laboratory-confirmed COVID-19 diagnosis admitted to hospital during the period 1 March to 31 May 2020. Participants A subgroup (n=185) with persisting symptoms still interfering with daily life at a telephone follow-up 4 months after discharge were invited for a medical and neuropsychological evaluation. Thirty-five of those who were assessed with a neurocognitive test battery at the clinical visit, and presented a clinical picture concerning for COVID-19-related brain pathology, were further investigated by brain MRI. Main outcome measures Findings on brain MRI, neurocognitive test results and reported fatigue. Results Twenty-five patients (71%) had abnormalities on MRI; multiple white matter lesions were the most common finding. Sixteen patients (46%) demonstrated impaired neurocognitive function, of which 10 (29%) had severe impairment. Twenty-six patients (74%) reported clinically significant fatigue. Patients with abnormalities on MRI had a lower Visuospatial Index (p=0.031) compared with the group with normal MRI findings. Conclusions In this group of patients selected to undergo MRI after a clinical evaluation, a majority of patients had abnormal MRI and/or neurocognitive test results. Abnormal findings were not restricted to patients with severe disease.

Digital media (DM), such as cellphones and tablets, are a common part of our daily lives and their usage has changed the communication structure within families. Thus, there is a risk that the use of DM might result in fewer opportunities for interactions between children and their parents leading to fewer language learning moments for young children. The current study examined the associations between childrens language development and early DM exposure. Participants: Ninety-two parents of 25months olds (50 boys/42 girls) recorded their home sound environment during a typical day [Language ENvironment Analysis (LENA)] and participated in an online questionnaire consisting of questions pertaining to daily DM use and media mediation strategies, as well as a Swedish online version of the MacArthur Communicative Development Inventory, which includes a vocabulary scale as well as a grammar and pragmatics scale. Results: Through correlations and stepwise regressions three aspects of language were analyzed. The childs vocabulary was positively associated with interactional turn-taking. The childs vocabulary and grammar were negatively associated with the likelihood of parents device use during everyday child routines and the amount of TV watched by the child. The childs pragmatic development was also positively associated with the parents device use in child routines but also with the parents joint media engagement (JME), as well as the childs gender (where girls perform better). Conclusion: Our study confirms that specific aspects of the 2-year olds DM environment are associated with the childs language development. More TV content, whether it is viewed on a big screen or tablet, is negatively associated with language development. The likelihood of parents use of DM during everyday child routines is also negatively associated with the childs language development. Positive linguistic parental strategies such as interactional turn-taking with the child, JME, and book reading, on the other hand, are positively associated with the childs language development.

Background: Premature birth affects opportunities for interaction between infants and mothers. Skin-to-skin contact (SSC) is standard care in neonatal care but has not been sufficiently studied regarding the effects on interaction between preterm infant and mothers. Purpose: The purpose of this study was to compare interaction between preterm infants and their mothers after continuous versus intermittent SSC from birth to discharge. A secondary aim was to study a potential dose-response effect between time in SSC and quality of interaction. Methods: Families were randomly assigned to either continuous (n = 17) or intermittent (n = 14) SSC before delivery. Interaction was measured from videotapes of a Still-Face Paradigm collected at 4 months corrected age. Face-to-face interaction was coded according to Ainsworths Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scales-R. Dose-response correlations were calculated between mean time spent in SSC and each of the interaction scales. Results: There were no statistically significant differences between groups in maternal interactive behavior toward their infants regarding sensitivity, interference, availability, acceptance, withdrawal, or intrusivity. There was no correlation between mean time in SSC and quality of interaction. Implications for Practice: Continuous SSC from birth to discharge was not superior to intermittent SSC concerning mother-infant interaction between preterm infants and their mothers at 4 months corrected age. However, compared with other studies, mean time in SSC was also high in the intermittent group. Implications for Research: Further studies are needed to find out how interaction between parents and preterm infants can be improved, supported, and facilitated in the neonatal intensive care unit (NICU) and whether there is an optimal dose for SSC.

Digital media availability has surged over the past decade. Because of a lack of comprehensive measurement tools, this rapid growth in access to digital media is accompanied by a scarcity of research examining the family media context and sociocognitive outcomes. There is also little cross-cultural research in families with young children. Modern media are mobile, interactive, and often short in duration, making them difficult to remember when caregivers respond to surveys about media use. The Comprehensive Assessment of Family Media Exposure (CAFE) Consortium has developed a novel tool to measure household media use through a web-based questionnaire, time-use diary, and passive-sensing app installed on family mobile devices. The goal of developing a comprehensive assessment of family media exposure was to take into account the contextual factors of media use and improve upon the limitations of existing self-report measures, while creating a consistent, scalable, and cost-effective tool. The CAFE tool captures the content and context of early media exposure and addresses the limitations of prior media measurement approaches. Preliminary data collected using this measure have been integrated into a shared visualization platform. In this perspective article, we take a tools-of-the-trade approach (Oakes, 2010) to describe four challenges associated with measuring household media exposure in families with young children: measuring attitudes and practices; capturing content and context; measuring short bursts of mobile device usage; and integrating data to capture the complexity of household media usage. We illustrate how each of these challenges can be addressed with preliminary data collected with the CAFE tool and visualized on our dashboard. We conclude with future directions including plans to test reliability, validity, and generalizability of these measures.

This article provides a description of eye movement data collected during an ocular-motor serial reaction time task. Raw gaze data files for 63 infants and 24 adults along with the data processing and analysis script for extracting saccade latencies, summarizing participants performance, and testing statistical differences, are hosted on Open Science Framework (OSF). Files (in Matlab format) available for download allow for replication of the results reported in "Procedural memory in infancy: Evidence from implicit sequence learning in an eye-tracking paradigm" [1]. (C) 2020 The Authors. Published by Elsevier Inc.

Procedural memory underpins the learning of skills and habits. It is often tested in children and adults with sequence learning on the serial reaction time (SRT) task, which involves manual motor control. However, due to infants slowly developing control of motor actions, most procedures that require motor control cannot be examined in infancy. Here, we investigated procedural memory using an SRT task adapted for infants. During the task, images appeared at one of three locations on a screen, with the location order following a five-item recurring sequence. Three blocks of recurring sequences were followed by a random-order fourth block and finally another block of recurring sequences. Eye movement data were collected for infants (n = 35) and adults (n = 31). Reaction time was indexed by calculating the saccade latencies for orienting to each image as it appeared. The entire protocol took less than 3 min. Sequence learning in the SRT task can be operationalized as an increase in latencies in the random block as compared with the preceding and following sequence blocks. This pattern was observed in both the infants and adults. This study is the first to report learning in an SRT task in infants as young as 9 months. This SRT protocol is a promising procedure for measuring procedural memory in infants. (C) 2019 Elsevier Inc. All rights reserved.

The language environment is important for the development of early communication and language. In the current study, we describe the natural home language environment of 9-month-old infants in Sweden and its concurrent association with language development. Eighty-eight families took part in the study. The home language environment was measured using the Language ENvironment Analysis (LENA) system, and language development was assessed using Swedish Early Communicative Development Inventory (SECDI), a parent questionnaire. LENA measures showed dramatic variation between individuals but were comparable to and showed overlapping variance with previous studies conducted in English-speaking households. Nonetheless, there were significantly more infant vocalizations and conversational turns in the present study than in one previous study. Adult word count correlated significantly and positively with infants Use of gestures and the subscale of that section Communicative gestures. These together with another four non-significant associations formed a consistent overall pattern that suggested a link between infants language environment and language development. Although the direction of causality cannot be determined from the current data, future studies should examine children longitudinally to assess the directionality or the bidirectionality of the reported associations between infants language environment and language development.

This study examined 307 elementary school children’s judgements and reasoning about bullying and other repeated transgressions when school rules regulating these transgressions have been removed in hypothetical school situations. As expected, children judged bullying (repeated moral transgressions) as wrong independently of rules and as more wrong than all the other repeated transgressions. They justified their judgement in terms of harm that the actions caused. Moreover, whereas children tended to judge repeated structuring transgressions as wrong independently of rules (but to a lesser degree than when they evaluated bullying) and justified their judgements in terms of the disruptive, obstructive or disturbing effects that the actions caused, they tended to accept repeated etiquette transgressions by arguing that the acts had no negative effects or simply that the rule had been removed. The findings confirm as well as extend previous social-cognitive domain research on children’s socio-moral reasoning.

Syftet med denna avhandling var att undersöka möjliga effekter av omega-3 fettsyror för barns kognition och beteende. Både kortsiktiga och långsiktiga effekter undersöktes och studierna involverade både barn med typisk utveckling och barn med ADHD.

De specifika syftena var att undersöka; (1) amning i relation till barns kognitiva utveckling; (2), relationen mellan långa fleromättade fettsyror (LCPUFA) i mammans bröstmjölk och barns kognition; (3) effekter på kognition och beteenden hos barn med ADHD av ett EPA tillskott; (4) om LCPUFA hade några differentiella effekter på arbetsminne, inhibering eller Theory of Mind (ToM).

De huvudsakliga slutsatserna var följande; (1) amningslängden var positivt korrelerad med barnens intelligenskvot (IK); (2) LCPUFA i bröstmjölken var associerad med barnens ToM och IK, kvoten DHA/AA, tillsammans med amningslängd och graviditetslängd förklarade 76% av variansen i totala IK; (3) subgrupper av barn med ADHD svarade på EPA behandlingen med signifikant reducerade symptom, men för hela gruppen med ADHD hittades inga effekter; (4) ToM var relaterat till LCPUFA, men inga andra kognitiva mått som arbetsminne, inhibering eller problemlösning.

Sammanfattningsvis indikerar dessa resultat att fettsyrestatus i bröstmjölk påverkar generell kognitiv förmåga, samt ToM, hos barn 6,5 år gamla. Korttidsintervention med omega-3 fetter påverkar inte kognition hos skolbarn med ADHD, men minskar kliniska symptom skattade i lärarskattningsskalor. Vidare indikerar resultaten att ”heta” exekutiva funktioner och social kognition kan vara av intresse för framtida forskning.

Aim: Measure efficacy of eicosapentaenoic acid (EPA) in children with attention deficit hyperactivity disorder (ADHD). Methods: Randomized controlled trial (RCT) of 0.5 g EPA or placebo (15 weeks) in 92 children (7-12 years) with ADHD. Efficacy measure was Conners Parent/Teacher Rating Scales (CPRS/CTRS). Fatty acids were analysed in serum phospholipids and red blood cell membranes (RBC) at baseline and endpoint with gas chromatography. Results: EPA improved CTRS inattention/cognitive subscale (p = 0.04), but not Conners total score. In oppositional children (n = 48), CTRS total score improved andgt;= 25% in 48% of the children receiving EPA vs. 9% for placebo [effect size (ES) 0.63, p = 0.01]. In less hyperactive/impulsive children (n = 44), andgt;= 25% improvement was seen in 36% vs. 18% (ES 0.41, n.s.), and with both these types of symptoms 8/13 with EPA vs. 1/9 for placebo improved andgt;= 25% (p = 0.03). Children responding to treatment had lower EPA concentrations (p = 0.02), higher AA/EPA (p = 0.005) and higher AA/DHA ratios (p = 0.03) in serum at baseline. Similarly, AA/EPA (p = 0.01), AA/DHA (p = 0.038) and total omega-6/omega-3 ratios (p = 0.028) were higher in RBC, probably because of higher AA (p = 0.011). Conclusion: Two ADHD subgroups (oppositional and less hyperactive/impulsive children) improved after 15-week EPA treatment. Increasing EPA and decreasing omega-6 fatty acid concentrations in phospholipids were related to clinical improvement.

Breast-milk provides nutrients required for the development of the brain. n-6 and n-3 long-chain polyunsaturated fatty acids (LCPUFAs) have been suggested to be particularly involved. In this study levels of fatty acids in breast-milk were examined in relation to theory of mind (ToM) (n=13) and WISC-III (n=22) in six-year-old children. ToM tasks comprised four illustrated stories with questions about emotional (sad) events. Single polyunsaturated fatty acids (PUFA) were estimated as well as ratios between different fatty acids in order to describe putative associations between PUFA and psychological measures. Results show correlations between both ToM and WISC-III with single n-6 PUFA and the ratios DHA/AA and DHA/DPA. The correlations remained when socio-demographic factors were statistically controlled for. The positive findings related to the n-6 and n-3 LCPUFAs corroborate previous findings related to child cognitive development. © 2006 Elsevier Ltd. All rights reserved.

Aim: Breastfeeding seems to be favorable for cognitive development. Could levels of polyunsaturated fatty acids (PUFA) explain this? Methods: Pregnant mothers were recruited consecutively at maternity care centres. PUFA were analysed in colostrum and breast milk at 1 and 3 mo. The product-precursor ratios of n-6+n-3 PUFA were examined as measures of activity in respective steps in the fatty acid metabolic chain. Also, the quotient between DHA and AA was analysed. The children were tested with the full WISC-III at 6.5 y. Results: First, the influence of length of breastfeeding was analysed by multiple regression together with relevant cofactors (except for PUFA). In the best models, 46% of the variation in total IQ was explained. Length of breastfeeding contributed significantly to total IQ (beta = 0.228, p = 0.021), verbal IQ (beta = 0.204, p = 0.040) and performance IQ (beta = 0.210, p = 0.056). There were no significant single correlations between PUFA and measures of cognitive development. However, in multiple regression analysis of colostrum, significant beta-coefficients were found for steps 4+5 in the fatty acid metabolic chain (beta = 0.559, p = 0.002). If length of breastfeeding and gestation week were added to steps 4+5, this three-factor model could explain 67% of the variation of total IQ. Introducing length of breastfeeding and gestation week together with the quotient DHA/AA (beta = 0.510, p < 0.001) yielded a three-factor model, which explained 76% of the variation in total IQ. Conclusion: Our findings could be interpreted as supporting the importance of high levels of PUFA for cognitive development. However, the sample is small and the results must be interpreted with caution.

OBJECTIVE: The goal of the present randomized placebo controlled double-blind study was to investigate the potential effect of PUFA supplementation on cognitive and behavioural performance in children with neurodevelopmental problems at 7 years of age (n = 28) and to compare findings with an age matched healthy control group (n = 20).

METHODS: Children were screened with parent and teacher rating scales (Conner’s and SNAP-IV), and were included if they showed a range of neurodevelopmental problems that reached ADHD criteria. The group with neurodevelopmental difficulties was randomized to treatment with an EPA rich formula (n = 13) or to placebo (n = 15). Cognitive performance was determined at baseline and after 15 weeks of supplementation with a cognitive test battery including executive function and theory of mind tasks.

RESULTS: Children with neurodevelopmental problems differed from the control group regarding working memory, inhibition and language ability, but not on an advanced theory of mind task. Regarding the treatment with EPA supplement there were no significant advantages in the active treatment group compared to placebo in any of the cognitive measures or in parents or teacher rating scales.

CONCLUSION: The significant differences in cognitive performance and rating scales between the group with neurodevelopmental problems and the healthy control group at baseline indicate problems at a clinical level and suitability for treatment. However we found no significant effects of PUFA supplementation. The study is small and limited by a number of drop-outs.