BackgroundOmega-3 fatty acids are dietary essentials, and the current low intakes in most modern developed countries are believed to contribute to a wide variety of physical and mental health problems. Evidence from clinical trials indicates that dietary supplementation with long-chain omega-3 may improve child behavior and learning, although most previous trials have involved children with neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD) or developmental coordination disorder (DCD). Here we investigated whether such benefits might extend to the general child population.ObjectivesTo determine the effects of dietary supplementation with the long-chain omega-3 docosahexaenoic acid (DHA) on the reading, working memory, and behavior of healthy schoolchildren.DesignParallel group, fixed-dose, randomized, double-blind, placebo-controlled trial (RCT).SettingMainstream primary schools in Oxfordshire, UK (n = 74).ParticipantsHealthy children aged 7–9 years initially underperforming in reading (≤33rd centile). 1376 invited, 362 met study criteria.Intervention600 mg/day DHA (from algal oil), or taste/color matched corn/soybean oil placebo.Main Outcome MeasuresAge-standardized measures of reading, working memory, and parent- and teacher-rated behavior.ResultsITT analyses showed no effect of DHA on reading in the full sample, but significant effects in the pre-planned subgroup of 224 children whose initial reading performance was ≤20th centile (the target population in our original study design). Parent-rated behavior problems (ADHD-type symptoms) were significantly reduced by active treatment, but little or no effects were seen for either teacher-rated behaviour or working memory.ConclusionsDHA supplementation appears to offer a safe and effective way to improve reading and behavior in healthy but underperforming children from mainstream schools. Replication studies are clearly warranted, as such children are known to be at risk of low educational and occupational outcomes in later life.Trial RegistrationClinicalTrials.gov NCT01066182 and Controlled-Trials.com ISRCTN99771026

BackgroundOmega-3 long-chain polyunsaturated fatty acids (LC-PUFA), especially DHA (docosahexaenonic acid) are essential for brain development and physical health. Low blood Omega-3 LC-PUFA have been reported in children with ADHD and related behavior/learning difficulties, as have benefits from dietary supplementation. Little is known, however, about blood fatty acid status in the general child population. We therefore investigated this in relation to age-standardized measures of behavior and cognition in a representative sample of children from mainstream schools.Participants493 schoolchildren aged 7–9 years from mainstream Oxfordshire schools, selected for below average reading performance in national assessments at age seven.MethodWhole blood fatty acids were obtained via fingerstick samples. Reading and working memory were assessed using the British Ability Scales (II). Behaviour (ADHD-type symptoms) was rated using the revised Conners’ rating scales (long parent and teacher versions). Associations were examined and adjusted for relevant demographic variables.ResultsDHA and eicosapentaenoic acid (EPA), accounted for only 1.9% and 0.55% respectively of total blood fatty acids, with DHA showing more individual variation. Controlling for sex and socio-economic status, lower DHA concentrations were associated with poorer reading ability (std. OLS coeff. = 0.09, p = <.042) and working memory performance (0.14, p = <.001). Lower DHA was also associated with higher levels of parent rated oppositional behavior and emotional lability (−0.175, p = <.0001 and −0.178, p = <.0001).ConclusionsIn these healthy UK children with below average reading ability, concentrations of DHA and other Omega-3 LC-PUFA were low relative to adult cardiovascular health recommendations, and directly related to measures of cognition and behavior. These findings require confirmation, but suggest that the benefits from dietary supplementation with Omega-3 LC-PUFA found for ADHD, Dyspraxia, Dyslexia, and related conditions might extend to the general school population.

Sleep problems in children are associated with poor health, behavioural and cognitive problems, as are deficiencies of long-chain omega-3 fatty acids such as docosahexaenoic acid. Theory and some evidence support a role for these fatty acids in sleep regulation, but this issue has received little formal investigation. We examined associations between blood fatty acid concentrations (from fingerstick blood samples) and subjective sleep (using an age-standardized parent questionnaire) in a large epidemiological sample of healthy children aged 7–9 years (n = 395) from mainstream UK schools. In a randomized controlled trial, we then explored whether 16-week supplementation (600 mg day−1) with algal docosahexaenoic acid versus placebo might improve sleep in a subset of those children (n = 362) who were underperforming in reading. In a randomly selected subsample (n = 43), sleep was also assessed objectively via actigraphy. In 40% of the epidemiological sample, Child Sleep Habits Questionnaire scores indicated clinical-level sleep problems. Furthermore, poorer total sleep disturbance scores were associated weakly but significantly with lower blood docosahexaenoic acid (std coeff. −0.105*) and a lower docosahexaenoic acid : arachidonic acid ratio (std coeff. −0.119**). The treatment trial showed no significant effects on subjective sleep measures. However, in the small actigraphy subsample, docosahexaenoic acid supplementation led on average to seven fewer wake episodes and 58 min more sleep per night. Cautiously, we conclude that higher blood levels of docosahexaenoic acid may relate to better child sleep, as rated by parents. Exploratory pilot objective evidence from actigraphy suggests that docosahexaenoic acid supplementation may improve children's sleep, but further investigations are needed.

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After three decades of welfare state crisis, change and transformation can we still speak of welfare state regimes when looking at their outcomes? The analysis of outcomes provides a picture of ‘the real worlds of welfare’ and is of considerable importance to understanding political legitimacy across countries. We use aggregate longitudinal data for West European countries in order to map welfare outcomes and cluster countries. The cluster results are also assessed for their sensitivity to the choice of different countries, years or indicators. All European welfare states have a significant capacity for reducing poverty and inequality. However, the degree of this reduction varies considerably, especially when examining different social groups, i.e. unemployed people, children, youths or the elderly. Outcomes cluster countries largely in line with previous institutionalist literature, differentiating between conservative, liberal, Mediterranean and social-democratic regimes. As the main exception, we identify Germany, which can no longer be characterised as the proto-typical conservative welfare state. When analysing old social risks such as unemployment and old age, Europe appears to be characterised by two groups, i.e. one consisting of liberal and Mediterranean countries and a second made up of social-democratic and conservative countries. New social risks such as child and youth poverty, by contrast, replicate very closely the theoretical four-cluster typology. Our sensitivity analyses reveal that our clusters tend to be stable over time. Welfare regimes continue to serve as a useful analytical tool and relate to outcomes experienced by European citizens.

This meta‐analysis assessed the impact of values affirmation on the academic achievement of students under social identity threats in actual classrooms. After a systematic search yielded 58 relevant studies, multilevel analyses identified an overall affirmation effect for identity‐threatened students (Hedges’ g = .15), not for identity‐nonthreatened students (Hedges’ g = .01). Heterogeneity in the affirmation effect was moderate to high for identity‐threatened students, with effect sizes associated with (1) a larger covariate‐controlled achievement gap between nonthreatened and threatened students in the control condition, suggestive of psychological underperformance, (2) the availability of financial resources in school, (3) more distal performance outcomes, and (4) the presentation of values affirmation as a normal classroom activity rather than a research study or a nonnormal classroom activity. Affirmation appears to work best when it is delivered as a normal classroom activity and where identity threat co‐occurs with resources for improvement and time to await cumulative benefits.

Interrupted time series designs are a valuable quasi-experimental approach for evaluating public health interventions. Interrupted time series extends a single group pre-post comparison by using multiple time points to control for underlying trends. But history bias—confounding by unexpected events occurring at the same time of the intervention—threatens the validity of this design and limits causal inference. Synthetic control methodology, a popular data-driven technique for deriving a control series from a pool of unexposed populations, is increasingly recommended. In this paper, we evaluate if and when synthetic controls can strengthen an interrupted time series design. First, we summarize the main observational study designs used in evaluative research, highlighting their respective uses, strengths, biases and design extensions for addressing these biases. Second, we outline when the use of synthetic controls can strengthen interrupted time series studies and when their combined use may be problematic. Third, we provide recommendations for using synthetic controls in interrupted time series and, using a real-world example, we illustrate the potential pitfalls of using a data-driven approach to identify a suitable control series. Finally, we emphasize the importance of theoretical approaches for informing study design and argue that synthetic control methods are not always well suited for generating a counterfactual that minimizes critical threats to interrupted time series studies. Advances in synthetic control methods bring new opportunities to conduct rigorous research in evaluating public health interventions. However, incorporating synthetic controls in interrupted time series studies may not always nullify important threats to validity nor improve causal inference.

, G. (2019). Video feedback for parental sensitivity and attachment security in children under five years (Review). Cochrane database of systematic reviews (Online), (11), 1.