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The study of child growth is complex. There are many clinical questions to answer but not necessarily the statistical methodology to deal with these questions. Human growth begins at conception and continues into adult life. In chapter 1 we discuss the characteristics of the growth process from conception to maturity and the purpose of growth monitoring. In chapter 2 we summarise the mathematical approaches to growth data. In chapter 3 we summarise the approaches that have been used to detect growth faltering. In this chapter we introduce the conditional gain Z-score. The data set analysed within this thesis is from the Newcastle growth and development study. In infancy we have routine weights of 3415 term infants. A sub-sample of these infants were followed-up at 7-9 years as part of a research study. These children belonged to three subgroups: cases were children that were defined as failing to thrive in infancy, controls were matched to cases and a 20% systematic sample. The school entry data of the sub-sample followed at 7-9 years were retrieved from school health records. In chapter 4 we carry out a preliminary analysis of the routine infancy weight Z-scores. The infancy data provided the opportunity to generate the correlation structure of routine weight Z-scores in infancy. In chapter 5 we develop a model for this correlation structure. In chapter 7 we explore patterns in the conditional weight gain Z-scores and also suggest some alternative criteria for identifying growth faltering in infancy. In chapters 6, 8 and 9 we analyse the anthropometric data obtained at follow-up and school entry. In childhood, the conditional gain Z-score is used to contrast height with mid-parental height and height at follow-up with height at school entry. The anthropometric data of the case and control children will be compared.

I examine the impact of hedge fund managers selling ownership stakes in their firms to outside owners. Funds with outside owners do not subsequently outperform a matched sample of funds but do attract higher flows, suggesting that managers sell stakes to obtain strategic growth partners. The flow impact is greater for i) funds with lower prior flows or performance, ii) smaller funds, and iii) funds with more reputable outside owners. Outsiders also monitor their investments as funds with outside owners reduce their returns management. The reduction in return management is stronger after the 2008 financial crisis when institutions’ reputations are more tarnished. Combined, the results indicate that outside ownership benefits managers, outsiders, and fund investors.

Infant growth is a key indicator of health and a relevant component of paediatric surveillance. Certain growth characteristics are also associated with greater risk for diseases such as obesity and cardiovascular disease. South Asian populations are known to demonstrate poor infant growth and suffer from a high prevalence of non-communicable disease. Relatively little is known about the growth of Pakistani infants, especially following migration. In the United kingdom (UK), infant growth is routinely monitored to detect poor health, and this process produces a repository of largely unutilised data. In 2009, new growth charts, which include a component of the World Health Organisation (WHO) growth standards, were introduced to routine practice. The adoption of prescriptive standards, which are based on breastfed infants living in an unconstrained environment, will have implications for the assessment of growth. To develop and assess the quality of routine growth monitoring data collected in Bradford, UK, so that it can be used to describe the differences in growth between White British and Pakistani infants in the same city. To investigate the factors that influence this growth. To assess the implications of adopting growth standards for practice. The frequency of routine growth monitoring data that are collected at prescribed age periods was assessed. Test-retest growth data were collected from 192 practitioners, and technical error of measurements were calculated. Data on 2464 (boys 51%, White British 45%) infants were submitted to multilevel modelling analysis to produce sex and ethnic specific weight-for-age, abdominal circumference-for-age, head circumference-for-age, and length-for-age growth curves between birth and nine months. Multivariable linear regression models were used to investigate factors that influence size at birth and at nine months. Growth curves were plotted against the WHO standards and the UK 1990 references, Z-scores were calculated, and the relative risks (RR) of underweight, obesity, and poor infant weight gain using the standards compared to the references were assessed. During each prescribed age period for routine growth monitoring generally only 30% to 35% of measurements were recorded. None of the technical error of measurements were excessively large, and coefficients of reliability ranged from 0.96 to 1.00. Multilevel models explained that Pakistani infants were smaller than White British infants, in the first nine months of life, for weight (-210.3g to -321.7g), abdominal circumference (-1.15cm to -0.39cm), head circumference (-0.59cm), and length (-0.32cm). Compared to the WHO standards, infants demonstrated dissimilar weight growth, but similar head circumference and length growth. The common weight growth pattern was slow growth between birth and two months, followed by rapid growth. Using the standards, infants were significantly less likely to be classified as underweight (RR at birth 0.496; 95% Confidence Interval 0.363 to 0.678) and demonstrating poor weight gain from birth to nine months (0.783; 0.644 to 0.952). Growth monitoring data are not collected at prescribed age periods, but following initial training of practitioners are reliable. Integrating research with practice has developed routine data to research calibre and has established protocols to make data more accessible. Pakistani infants were consistently smaller than White British infants, and, despite efforts, the determinants of this phenomenon have not yet been fully elucidated. Growth in weight of infants in Bradford differs significantly from that represented by the WHO standards, and without adequate training of practitioners infant growth may be incorrectly interpreted.

Made available in DSpace on 2014-12-17T14:46:57Z (GMT). No. of bitstreams: 1 SamaraKDB_DISSERT.pdf: 1388036 bytes, checksum: d582f2055c29a12c4b64a24bc155b77f (MD5) Previous issue date: 2013-02-27 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The nurses assistance in monitoring the growth and development of children has been characterized mostly a service based on the biological dimension of illness, when in reality, the actions should be combined in the reorientation of care model of the Family Health Strategy. Thus, the research aimed to examine the role of nurses in the growth and development of children. This is an exploratory and descriptive, qualitative approach. The project was approved by the Ethics Committee of the Universidade Federal do Rio Grande do Norte under Opinion No. 191/2012. Data collection was developed in the Health Units from the city of Natal, RN, Brazil. Survey participants were nurses who worked in the Family Health Strategy for at least two years and who performed the monitoring of child growth and development in the health unit selected. Data were collected through an in-depth interview, and seized material from speeches was treated as categorical thematic analysis proposed by Bardin. This process revealed three themes, which were analyzed in the light of Relief Models and Process Work in Health and Nursing and discussed based on the findings literary. The results elucidated that nurses consider their performance satisfactory as it has favored the accession of mothers of children under one year nursing visits, contributing to the reduction of morbidity and mortality due to prevalent diseases, as well as the establishment of a connection between the professionals and mothers. It was shown that despite having a promotion and prevention with the use of lightweight technologies, the nurses also emphasized the care of mothers in complaints and signs and symptoms of children, followed by referrals to professionals in the unit or to other sectors. Furthermore, we found that the process of working nurses face challenges regarding the organizational structure of services and social situation of the family. Given these statements, it is observed that despite the strong interference from hegemonic health model in the performance of nurses, it is found that these professionals have been investing in promotion and prevention to injuries to children in care, with a focus on family context. Thus, nurses are embarking on making the reorientation of health care through the use of relational technologies, which has contributed to solving the integral care to the pediatric population / A assist?ncia do enfermeiro no acompanhamento do crescimento e desenvolvimento da crian?a tem se caracterizado, em sua maioria, num atendimento baseado na dimens?o biol?gica do adoecer, quando na realidade, as a??es deveriam estar conjugadas na reorienta??o de modelo assistencial da Estrat?gia Sa?de da Fam?lia. Deste modo, a pesquisa teve como objetivo analisar a atua??o do enfermeiro no acompanhamento do crescimento e desenvolvimento da crian?a. Trata-se de um estudo explorat?rio e descritivo, em uma abordagem qualitativa. O projeto foi aprovado pelo Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte sob parecer de n? 191/2012. A coleta de dados desenvolveu-se nas Unidades de Sa?de da Fam?lia do munic?pio de Natal-RN, Brasil. Os participantes da pesquisa foram ?s enfermeiras que atuavam na Estrat?gia Sa?de da Fam?lia por no m?nimo dois anos, e que realizavam o acompanhamento do crescimento e desenvolvimento da crian?a na unidade de sa?de selecionada. Os dados foram obtidos mediante uma entrevista em profundidade, e o material apreendido dos discursos foi tratado conforme a an?lise categorial tem?tica proposta por Bardin. Deste processo emergiram tr?s categorias tem?ticas, as quais foram analisadas ? luz dos Modelos Assistenciais e do Processo de Trabalho em Sa?de e de Enfermagem e discutidos com base nos achados liter?rios. Os resultados elucidaram que as enfermeiras consideram a sua atua??o satisfat?ria, pois tem favorecido na ades?o das m?es dos menores de um ano ?s consultas de enfermagem, na contribui??o para a redu??o da morbidade e mortalidade infantil por doen?as prevalentes, bem como no estabelecimento de v?nculo entre as profissionais e genitoras. Foi evidenciado, que apesar de realizarem a??es de promo??o e preven??o com a utiliza??o de tecnologias leves, as enfermeiras ainda enfatizam o cuidado nas queixas das m?es e sinais e sintomas das crian?as, seguido dos encaminhamentos aos profissionais da unidade ou a outros setores. Al?m disso, constatou que o processo de trabalho das enfermeiras enfrenta desafios quanto ? estrutura organizacional dos servi?os e da conjuntura social da fam?lia. Diante destas coloca??es, observa-se que apesar da forte interfer?ncia do modelo de sa?de hegem?nico na atua??o das enfermeiras, ? verificado que estas profissionais v?m investindo em a??es de promo??o e preven??o aos agravos no cuidado ?s crian?as, com o foco no contexto familiar. Assim, as enfermeiras est?o enveredando o fazer na reorienta??o do modelo assistencial de sa?de, mediante a utiliza??o das tecnologias relacionais, o que tem contribu?do para a resolutividade do cuidado integral a popula??o infantil

La surveillance de la croissance des enfants est une activité quasi-universelle visant principalement à repérer des affections graves chez des enfants apparemment sains. Il existe des preuves empiriques que les performances de cette surveillance sont faibles, ce qui pourrait s’expliquer par l’absence de consensus sur trois questions clés et interdépendantes : quelles sont les affections à cibler en priorité ? comment définir une croissance anormale ? et quelles sont les courbes de croissance à utiliser ?Nous avons montré qu’il existait une grande hétérogénéité des pratiques de surveillance de la croissance en Europe et que les sept algorithmes proposés pour définir une croissance anormale avaient des performances et/ou un niveau de validation faible. Nous avons réalisé une étude de validation externe et une comparaison face-à-face de ces algorithmes et démontré que la règle de Grote avait les meilleures performances. Nous avons montré que la croissance des enfants français contemporains était plus proche des courbes de l’OMS que des courbes de référence françaises, excepté dans les six premiers mois de vie, et que l’introduction des courbes de l’OMS augmenterait la sensibilité des algorithmes au détriment de leurs spécificités. Nous avons obtenu un consensus d’experts internationaux sur la typologie des affections cibles prioritaires et un consensus national sur une liste réduite de huit affections cibles prioritaires des algorithmes de surveillance de la croissance.Ces connaissances nouvelles permettront très probablement de proposer des outils plus valides pour la surveillance de la croissance et de standardiser les pratiques pour améliorer la santé des enfants. / Growth monitoring in children is a worldwide health activity which aims at early detection of serious underlying disorders of apparently healthy children. Existing empirical evidence shows that growth-monitoring performance were low, this can be explained by a lack of consensus on three key and interconnected questions: which conditions should be targeted? how should abnormal growth be defined? and which growth charts should be used?We showed that there is a large heterogeneity in growth-monitoring practices in Europe and that the seven algorithms proposed for defining an abnormal growth had low performance and/or a level of validation. We performed an external validation study and head-to-head comparison of these seven algorithms and demonstrated that the Grote clinical rule had the best performance. We found that the growth of contemporary French children were closer to the WHO than French growth charts, except during the first six month of life. The introduction of WHO growth charts would increase the sensitivity at the expense of their specificity. We obtained an international consensus on the typology of priority target conditions and national consensus on a short list of eight priority target conditions of growth-monitoring algorithms.This new knowledge will most likely allow developing validated tools for growth monitoring and standardizing practices for improving child outcomes.

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)

The objectives of this study were to determine the nature of data recorded on the Road to Health Card (RtHC) and its utilisation by nurses at primary health care setting, comparing it with norms and standards on the RtHC guideline, and to provide guidelines for optimal utilisation of the RtHC by health workers. A quantitative nonexperimental descriptive method was used. Two methods were used to collect data; document analysis of the RtHC and structure observation of nurses. A structured exit interview of caregivers was conducted to validate observations from nurses. A sample size of 18 nurses from all categories from six clinics was observed, and 36 RtHC of children under five years of age were analysed. Results indicated that data recorded on the RtHC was mostly inaccurate, incomplete and not interpreted. The study identified a need to train health workers on optimal utilisation of the RtHC facilitating health improvement of children under five years of age. / Health Studies / M.A. (Health Studies)

The prevalence of Protein-Energy Malnutrition (PEM) in South Africa has been welldescribed in previous research studies and yet little is known about the nutritional status of toddlers in the Vosloorus Township. Using the research questions as the conceptual framework for the study, an exploratory descriptive survey was conducted to determine. • What factors give rise to malnutrition in the Vosloorus Township? • Why do toddlers on the PEM Programme fail to achieve their expected target weight? Data was collected by means of structured interviews from a sample of 50 mothers in the Vosloorus Township whose toddlers were on the PEM Programme. The fmdings indicated that the poor socio-economic conditions of the majority of households, especially unemployment, low levels of education and ignorance, contributed towards the development of malnutrition amongst toddlers and their failure to thrive on the PEM Programme. Recommendations to reduce levels of malnutrition and transform existing nutrition programmes were made. / Health Studies / M.A. (Nursing Science)

The prevalence of Protein-Energy Malnutrition (PEM) in South Africa has been welldescribed in previous research studies and yet little is known about the nutritional status of toddlers in the Vosloorus Township. Using the research questions as the conceptual framework for the study, an exploratory descriptive survey was conducted to determine. • What factors give rise to malnutrition in the Vosloorus Township? • Why do toddlers on the PEM Programme fail to achieve their expected target weight? Data was collected by means of structured interviews from a sample of 50 mothers in the Vosloorus Township whose toddlers were on the PEM Programme. The fmdings indicated that the poor socio-economic conditions of the majority of households, especially unemployment, low levels of education and ignorance, contributed towards the development of malnutrition amongst toddlers and their failure to thrive on the PEM Programme. Recommendations to reduce levels of malnutrition and transform existing nutrition programmes were made. / Health Studies / M.A. (Nursing Science)