BackgroundIn 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0–5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework. MethodsThe development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines.ResultsBased on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (<1 year), toddlers (1–2 years) and preschoolers (3–5 years).ConclusionsTo our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, ...

Patterns of parent-child interaction and communication within the normal range have environmentally mediated effects on language and account for twin-singleton differences in language developmently. The results indicate the value of a natural experiment in testing competing causal hypotheses, and show the role of environmental factors as influences on language variations within the normal range, for both twins and singletons.

OBJECTIVE: Report long-term outcomes of the NOURISH randomized controlled trial (RCT), which evaluated a universal intervention commencing in infancy to provide anticipatory guidance to first-time mothers on "protective" complementary feeding practices that were hypothesized to reduce childhood obesity risk. METHODS:The NOURISH RCT enrolled 698 mothers (mean age 30.1 years, SD = 5.3) with healthy term infants (51% female). Mothers were randomly allocated to usual care or to attend two 6-session, 12-week group education modules. Outcomes were assessed 5 times: baseline (infants 4.3 months); 6 months after module 1 (infants 14 months); 6 months after module 2 (infants 2 years) and at 3.5 and 5 years of age. Maternal feeding practices were self-reported using validated questionnaires. BMI Z-score was calculated from measured child height and weight. Linear mixed models evaluated intervention (group) effect across time.RESULTS: Retention at age 5 years was 61%. Across ages 2 to 5 years, intervention mothers reported less frequent use of nonresponsive feeding practices on 6 of 9 scales. At 5 years, they also reported more appropriate responses to food refusal on 7 of 12 items (Ps # .05). No statistically significant group effect was noted for anthropometric outcomes (BMI Z-score: P = .06) or the prevalence of overweight/obesity (control 13.3% vs intervention 11.4%, P = .66).CONCLUSIONS: Anticipatory guidance on complementary feeding resulted in first-time mothers reporting increased use of protective feeding practices. These intervention effects were sustained up to 5 years of age and were paralleled by a nonsignificant trend for lower child BMI Z-scores at all postintervention assessment points.WHAT'S KNOWN ON THIS SUBJECT: "Protective" complementary feeding practices that promote self-regulation of intake and development of healthy food preferences have been positively associated with healthy child eating patterns and growth. There are few high-quality trials evaluating feeding practice interventions; none has reported long-term outcomes. WHAT THIS STUDY ADDS:This large randomized controlled trial demonstrates that anticipatory guidance on the "how" of complementary feeding resulted in more protective feeding practices. These intervention effects were sustained for 3 years and translated into commensurate trends in obesity risk. Dr Daniels conceived the study; led the design, successful funding applications, and overall implementation of the study; and wrote the first draft of the paper; Dr Mallan undertook the statistical analysis and drafted the Results and Methods sections; Dr Nicholson contributed to funding applications, intervention development, and design of outcome assessments; Dr Thorpe contributed to funding application and measure development; Dr Nambiar coordinated study implementation and contributed to data collection and entry; Ms Mauch contributed to the design and delivery of the intervention modules and data collection; Dr Magarey contributed to the design, funding applications, developme...

It is concluded that obstetric/perinatal features do not account for the slower language development in twins as compared with singletons, within a sample born after at least 33 weeks gestation.

mini-mental state in a British community survey. J Psvchiatr Res 1989;23: 87-96. 13 O'Connor DW, Pollitt PA, Hyde JB, Fellowes JF, Miller ND, Roth M. A follow-up study of dementia diagnosed in the community using the Cambridge mental disorders of the elderly examination. . 4cia Pysvchiatr Scand 1990;81:78-82. 14 O'Connor DW, I'ollitt PA, Brook CPB, Reiss BB. The validit-of informant histories in a community studs of dementia. InternationalJ7ournal oJlGeriatrtc Subjects-139 mothers of twins-122 pairs of twins and 17 twins whose cotwin had died-and 12 573 controls, who were mothers of singletons.Results-A significantly higher proportion of mothers of twins at 5 years had malaise scores indicative of depression than mothers of singletons at the same age. Mothers who had borne twins, one of whom had subsequently died, had the highest malaise scores and were three times more likely than mothers of singletons to experience depression. Both mothers of twin pairs and mothers of singletons closely spaced in age were at significantly higher risk of experiencing depression than mothers of children widely spaced in age or mothers of only one child (p<0-0001). Odds ratios indicated that the risk of depression in mothers of twins was higher than that in mothers of closely spaced singletons.Conclusion-Mothers of twins are more likely to experience depression. This suggests a relation between the additional and exceptional stresses that twins present and the mother's emotional wellbeing. IntroductionThe role of stressors in increasing vulnerability to depression is well recorded. Life events (for example, death, illness, and separation) and stressful life circumstances (such as poverty, unemployment, disability, and marital discord) have been shown to be associated with the onset and maintenance ofdepressive states.`Among mothers, additionally, serious doubts about having the child,8 obstetric problems,9 and

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