Eff ects of a parenting intervention to address maternal psychological wellbeing and child development and growth in rural Uganda: a community-based, cluster-randomised trial

Background Parenting interventions have been implemented to improve the compromised developmental potential among 39% of children younger than 5 years living in low-income and middle-income countries. Maternal wellbeing is important for child development, especially in children younger than 3 years who are vulnerable and dependent on their mothers for nutrition and stimulation. We assessed an integrated, community-based parenting intervention that targeted both child development and maternal wellbeing in rural Uganda. Methods In this community-based, cluster randomised trial, we assessed the eff ectiveness of a manualised, parenting intervention in Lira, Uganda. We selected and randomly assigned 12 parishes (1:1) to either parenting intervention or control (inclusion on a waitlist with a brief message on nutrition) groups using a computergenerated list of random numbers. Within each parish, we selected two to three eligible communities that had a parish offi ce or a primary school in which a preschool could be established, more than 75 households with children younger than 6 years, and at least 15 socially disadvantaged families (ie, maternal education of primary school level or lower) with at least one child younger than 36 months. Participants within communities were mother–child dyads, where the child was 12–36 months of age at enrolment, and the mother had low maternal education. In the parenting intervention group, participants attended 12 fortnightly peer-led group sessions focusing on child care and maternal wellbeing. The primary outcomes were cognitive and receptive language development, as measured with the Bayley Scales of Infant Development, 3rd edn. Secondary outcomes included self-reported maternal depressive symptoms, using the Center for Epidemiologic Studies Depression Scale, and child growth. Theoreticallyrelevant parenting practices, including the Home Observation for Measurement of the Environment inventory, and mother-care variables, such as perceived spousal support, were also assessed as potential mediators. Baseline assessments were done in January, 2013, and endline assessments were done in November, 2013, 3 months after completion of the programme. Ethics approval was received from Mbarara and McGill universities. This trial is registered with ClinicalTrials.gov, NCT01906606. Findings Between December, 2012, and January, 2013, 13 communities (194 dyads) were randomly assigned to receive intervention, and 12 communities (154 dyads) were assigned to a waitlist control. 319 dyads completed baseline measures (171 in the intervention group and 148 in the control group), and 291 dyads completed endline measures (160 in the intervention group and 131 in the control group). At endline, children in the intervention group had signifi cantly higher cognitive scores (58∙90 vs 55∙65, eff ect size 0∙36, 95% CI 0∙12–0∙59) and receptive language scores (23∙86 vs 22∙40, 0∙27, 0∙03–0∙50) than did children in the control group. Mothers in the intervention group reported signifi cantly fewer depressive symptoms (15∙36 vs 18∙61, –0∙391, –0∙62 to –0∙16) than did mothers in the control group. However, no diff erences were found in child growth between groups. Interpretation The 12 session integrated parenting intervention delivered by non-professional community members improved child development and maternal wellbeing in rural Uganda. Because this intervention was largely managed and implemented by a local organisation, using local community members and minimal resources, such a programme has the potential to be replicated and scaled up in other low-resource, village-based settings

Evaluation of an Early Childhood Parenting Programme in Rural Bangladesh

To promote physical and mental development of children, parenting education programmes in developing countries focus on specific practices such as age-appropriate responsive stimulation and feeding. A programme delivered to groups of poor mothers of children, aged less than three years, in rural Bangla-desh was evaluated using an intervention-control post-test design. Mothers (n=170) who had attended a year of educational sessions and their children were compared with those (n=159) from neighbouring villages who did not have access to such a programme. After covariates were controlled, the parenting mothers obtained higher scores on a test of child-rearing knowledge and on the Home Observation for Measurement of the Environment (HOME) inventory of stimulation. The parenting mothers did not communicate differently with their children while doing a picture-talking task, and children did not show benefits in nutritional status or language comprehension. Parenting sessions offered by peer educators were informative and participatory, yet they need to include more practice, problem-solving, and peer-support if information is to be translated into behaviour

Enhanced REC collaborative review through video-conferencing

As international collaborative health research activities increase, building research ethics committees (REC) infrastructure and capacity in lowand middle-income countries for efficient and thorough review of research protocols becomes more critical, especially in sub-Saharan Africa. International investigators may face multiple challenges when conducting research in these settings, an important one being the length of time involved in securing REC review and approval. We discuss an approach to the problem that involved organisation of ‘rapid review’ REC sub-committees who met via video-conference for collaborative review of research protocols

Reaching expert consensus on training different cadres in delivering early childhood development: technical report

The Sustainable Development Goals (SDGs) signal a greater focus on inter-sectoral, collaborative approaches to ensuring that all human beings can fulfil their potential in dignity and equality. This is reflected in the current global concern with promotion of holistic, community-based programmes to support early childhood development and wellbeing ? widely referred to as ?early childhood development? (ECD). Within this context, the study reported here sought to achieve consensus among 14 global experts on training needs for three groups of personnel (?cadres?) involved in delivery of early childhood development (ECD) programmes. The three cadre groups, identified via a comprehensive review of literature on current issues in the provision of ECD, comprise delivery of education, health and community-based early childhood interventions across a diverse range of low resource settings. The study responds to a gap in knowledge on training needs for ECD cadres, associated with a serious dearth of human resources to support provision of ECD services. Key challenges reported here, based on comprehensive review of available literature, include: 1. A long-running, severe global shortage in availability of cadres to support delivery of ECD programmes. 2. To date, delivery of key health and education interventions principally in siloes, with limited integration and practitioners/professionals/para-professionals widely employed in vertical programmes. 3. Low professional and social status of many ECD cadres, due to a lack of systematic recognition and support. This has resulted in large numbers of cadres with undefined career paths, and high rates of turnover / attrition2. In response, expert consensus points to the following potential strategies for enhancing provision of ECD cadres training and professional development: 1. Development of coherent systems to support ECD training and professional development. a. Findings indicate consensus around commonalities among and distinctions between essential skills and knowledge required for education professionals, health professionals and non-certified para-professional groups. These insights could provide a basis for establishing coherent, joined-up professional pathways and support systems for development of ECD cadres. b. Consensus around the respective roles of these three cadres is reflected in the distinct training needs outlined for each group. There is consensus that, while noncertified para-professionals require programme-specific training to facilitate delivery of particular tasks, certified education and health professionals require training in more advanced skills such as problem-solving and flexibility. Exposure to a range of different programmes and approaches is required for certified professionals, to facilitate informed decision making around programme development and adapting / responding to local contextual needs. These distinctions could provide a basis for establishing clarity in respective roles for ECD cadres with regard to programme delivery. c. Consensus around training needs across cadre groups is indicated, in particular the need for on-going mentoring and supervision. While there is acknowledgment among experts about complexities associated with provision of on-going support, consensus around this component of training was strongest among all aspects surveyed. This reflects widespread concern among participating experts, as well as within the literature, that short-term training for ECD cadres must be followed up with opportunities for continuing professional development and systematic support, to facilitate sustained effective practice. 2. Within systems for ECD cadres training, a strong focus on the importance of contextually grounded programmes, materials / resources and strategies for implementation. a. There is strong consensus that ECD cadres training should be contextually-grounded to ensure responsive, effective provision. Training should be based on and promote careful consideration of a range of factors that shape provision of ECD, including but not restricted to, policy, budgets, available resources, local values, beliefs and practices. 3. Adoption of the concept of nurturing care as an underpinning principle for provision of ECD cadres training. a. Delphi findings indicate consensus around essential dispositions, or attitudes, required to support caring, respectful, responsive and trustful interactions with children, caregivers and communities. They also indicate that all cadres require knowledge and skills in promoting early stimulation; child-centred learning and development; effective communication and collaboration; problem solving, and reflective practice. These strategies are outlined in the proposed framework provided below, which identifies unique roles / training needs for different cadre groups, as well as opportunities for enhancing integration across ECD cadres training systems. 3 Experts suggest that these ?dispositions?, which are essential for effective provision, should be viewed as malleable. Training should work / be designed to promote, model and strengthen these characteristics

Apolipoprotein E expression is elevated by interleukin 1 and other interleukin 1-induced factors

<p>Abstract</p> <p>Background</p> <p>We have previously outlined functional interactions, including feedback cycles, between several of the gene products implicated in the pathogenesis of Alzheimer's disease. A number of Alzheimer-related stressors induce neuronal expression of apolipoprotein E (ApoE), β-amyloid precursor protein (βAPP), and fragments of the latter such as amyloid β-peptide (Aβ) and secreted APP (sAPP). These stressors include interleukin-1 (IL-1)-mediated neuroinflammation and glutamate-mediated excitotoxicity. Such circumstances are especially powerful when they transpire in the context of an <it>APOE </it>ε4 allele.</p> <p>Methods</p> <p>Semi-quantitative immunofluorescence imaging was used to analyze rat brains implanted with IL-1β slow-release pellets, sham pellets, or no pellets. Primary neuronal or NT2 cell cultures were treated with IL-1β, glutamate, Aβ, or sAPP; relative levels of ApoE mRNA and protein were measured by RT-PCR, qRT-PCR, and western immunoblot analysis. Cultures were also treated with inhibitors of multi-lineage kinases--in particular MAPK-p38 (SB203580), ERK (U0126), or JNK (SP600125)--prior to exposure of cultures to IL-1β, Aβ, sAPP, or glutamate.</p> <p>Results</p> <p>Immunofluorescence of tissue sections from pellet-implanted rats showed that IL-1β induces expression of βAPP, IL-1α, and ApoE; the latter was confirmed by western blot analysis. These protein changes were mirrored by increases in their mRNAs, as well as in those encoding IL-1β, IL-1β-converting enzyme (ICE), and tumor necrosis factor (TNF). IL-1β also increased ApoE expression in neuronal cultures. It stimulated release of sAPP and glutamate in these cultures too, and both of these agents--as well as Aβ--stimulated ApoE expression themselves, suggesting that they may contribute to the effect of IL-1β on ApoE levels. Inhibitors of MAPK-p38, ERK, and JNK inhibited ApoE induction by all these agents except glutamate, which was sensitive only to inhibitors of ERK and JNK.</p> <p>Conclusion</p> <p>Conditions of glial activation and hyperexcitation can elevate proinflammatory cytokines, ApoE, glutamate, βAPP, and its secreted fragments. Because each of these factors promotes glial activation and neuronal hyperexcitation, these relationships have the potential to sustain self-propagating neurodegenerative cycles that could culminate in a progressive neurodegenerative disorder such as Alzheimer's disease.</p

Assessing children’s implicit attitudes using the Affect Misattribution Procedure

In the current research we examined whether the Affect Misattribution Procedure (AMP; Payne et al., 2005) could be successfully adapted as an implicit measure of children’s attitudes. We tested this possibility in three studies with 5 to 10 year old children. In Study 1 we found evidence that children misattribute affect elicited by attitudinally positive (e.g., cute animals) and negative (e.g., aggressive animals) primes to neutral stimuli (inkblots). In Study 2, we found that, as expected, children’s responses following flower and insect primes were moderated by gender. Girls (but not boys) were more likely to judge inkblots as pleasant when they followed flower primes. Children in Study 3 showed predicted affect misattribution following happy as compared to sad face primes. In addition, children’s responses on this child-friendly AMP predicted their self-reported empathy; the greater children’s spontaneous misattribution of affect following happy and sad primes, the more children reported feeling the joy and pain of others. These studies provide evidence that the AMP can be adapted as an implicit measure of children’s attitudes and the results of Study 3 offer novel insight into individual differences in children’s affective responses to the emotional expressions of other

The Conversation of Critical Practice: Pre-service Teachers As Educators for Social Justice

In this paper we examine aspects of the construction of authentic membership, competence, and sense of shared purpose within a professional community of educators accomplished by a class of pre-service teachers during a spontaneous electronic conversation. Implications for teacher education are considered