Development and implementation of health promotion activities for the prevention of adolescent pregnancies

Of the eight Millennium Development Goals (MDGs) established in 2000 by the World Health Organisation, Millennium Development Goals 5 aimed at improving maternal health by addressing the high maternal mortality rate and increasing universal access to reproductive health by 2015.Adolescent pregnancy contributes to maternal, perinatal and infant mortality and also worsens the empowerment of young girls by negatively affecting their physical, educational, social, and economic development.This is a pressing public health concern in South Africa. The reduction of adolescent pregnancy is vital for achieving the sustainable human, health social and economic development of society at large. Culturally sensitive interventions to prevent adolescent pregnancies not only integrate the communities' norms, values, practices and behavioural patterns into the intervention's design and implementation but also the historical, social and economic contexts in which they exist. Progress has been made on the research on health promotion and education in South Africa; however communities are often not consulted on the design and conduct of health promotion research projects.The aim of the study was to develop and implement culturally sensitive and appropriate health promotion activities for the prevention of adolescent pregnancy in Grahamstown, Glenmore and Ndwayana communities in the Eastern Cape, South Africa.Two community based organisations and community care workers associated with them participated in this Community Based Participatory Research using the PEN-3 cultural model. The first phase of this study involved semi-structured interviews carried out with 14 community care workers to identify factors and consequences of adolescent pregnancies in their respective communities. The audio-recorded interviews were transcribed and coded using NVivo® 2010 software. The PEN 3 cultural model was adopted in the studyto address the socio-cultural factors contributing to adolescent pregnancy in the communities. The second phase involved a series of interactive workshops with CCWs for a participatory development of the facilitator's manual. Responses from CCWs informed the design of this study's intervention strategies. A facilitator's manual was developed to implement health promotion intervention, leading to the third phase of this study. The guided implementationof the health promotion intervention for the prevention of adolescent pregnancy was carried out over a period of 14 months and evaluated in the final phase of the study. The facilitator's manual was modified based on feedback fromCCWs, on possible improvements and cultural appropriateness. Readability testing guided the final modification of the manual. According to the community care workers, there were a number of adolescents who fell pregnant in their communities each year. The CCWs identified the influence of family members, friends and other stakeholders as contributory factors to adolescent pregnancy. They identified the lack of parental support in informing and educating adolescents about sexual health. Adolescents themselves lacked the maturity to recognise the risks and consequences of adolescent pregnancy. The negative perceptions of contraception in the community were discouraging contraceptive use amongst the adolescents. However, the results showed that enablers such as home and school visits done by the community care workers can be utilised to prevent adolescent pregnancy. Other factors included lack of health promotion materials and activities with information about preventing of adolescent pregnancy, and if available, the material is in English, that the adolescents may not comprehend. Socio-economic factors such as poverty, the Child Support Grant, cross generational relationships and coerced sex further contributed to adolescent pregnancy in the communities.CCWs identified the need for a more comprehensive health promotion intervention to prevent of adolescent pregnancy. A facilitator's manual addressing the prevention of adolescent pregnancy was developed and modified through a series participatory workshops with the community care workers.The facilitator's manual was used by CCWs to conducthealth promotion activities encouraging the prevention of adolescent pregnancies within the community's clinics, schools and during home visits. Community based participatory research methods and the PEN-3cultural model were used to develop this culturally sensitive and community specific adolescent pregnancy intervention for and by the CCWs. The participatory development of the facilitator's manual and the regular interactive workshops with the CCWs were strengthened by embedding this project into the development programs of the two non-governmental organisations contributing to sustainable development programs for women and children

Biophysical Investigations of the Aβ Aggregation Process

The presence in patient’s brain tissues of neuritic plaques containing Aβ aggregates is one of the pathological hallmarks of Alzheimer’s disease (AD), and Aβ aggregates have been implicated in the disease mechanism. These facts have inspired a large number of biophysical and structural studies on Aβ behavior over the last 25 years. Much remains to be learned, but there are a number of barriers to progress, including the challenges of making and manipulating these peptides and understanding their aggregation behavior. This thesis describes an improved method for the chemical synthesis of highly aggregation prone peptides like Aβ, insights into some previously unrealized limitations of a widely used “disaggregation” procedure for making high quality monomer solutions, and two fundamental studies on aspects of Aβ self-assembly. The improved synthesis method involves reversible addition of Lys residues to the C-terminus of the peptide during solid phase synthesis, which we show improves the synthetic yield and also improves the chromatographic behavior of the peptide during purification. The new knowledge about disaggregation reveals that a method involving sequential treatment of peptides with trifluoroacetic acid (TFA) and hexafluoroisopropanol (HFIP), while very effective with Aβ40, can alter the self-assembly of Aβ42, compared with an alternative protocol, and introduce highly stable oligomers that may possess substantial toxicity. In one fundamental study, we show that the minor brain form, Aβ43, aggregates more slowly than Aβ42 to make amyloid fibrils that are highly inefficient at seeding Aβ42 monomers. In another study, we describe the surprising result that amyloid fibrils of D-Aβ40 can seed L-Aβ40 monomers, and vice versa, suggesting a curious lack of structural discrimination to the prion-like propagation of Aβ amyloid in vitro. The results add to our knowledge of Aβ amyloid assembly and how it can best be studied in the laboratory

Application of the PEN-3 Cultural Model in Assessing Factors affecting Adolescent Pregnancies in Rural Eastern Cape, South Africa

Early pregnancy and child birth increases the health risk for the mother and the baby. It is a public health concern in South Africa as it may affect the health; social and economic well-being of society at large. Although immediate determinants of teenage pregnancy in South Africa relate to behaviour, the fundamental drivers are more deeply rooted institutional problems of poverty, underdevelopment and gender based violence. In addition, government policies, socio-economic injustices, unequal power structures and culture contribute to the high rates of teenage pregnancies in South Africa. The aim of this study was to assess contributing to adolescent pregnancies with in three rural communities in Eastern Cape Province. Guided by the PEN-3 cultural model and Community-based participatory research principles, an explorative qualitative research design was undertaken with 14 community care workers from Glenmore, Ndwayana and Grahamstown. As phase one of an ongoing study, semi-structured interviews were carried out with the participants. The results were coded according to the domains of the PEN 3 model. The main findings indicated that adolescent pregnancies are a significant cause for concern in the communities under study. Perceptions (myths surrounding contraceptive use), enablers (availability of clinics), and nurturers (parents, peers and boyfriends) were found to be important in making decisions regarding contraceptive use and sexual activity amongst adolescents. These factors identified will inform the development of culturally sensitive and appropriate health promotion material during the next phase of the stud

Application of the PEN-3 Cultural Model in Assessing Factors affecting Adolescent Pregnancies in Rural Eastern Cape, South Africa

Early pregnancy and child birth increases the health risk for the mother and the baby. It is a public health concern in South Africa as it may affect the health; social and economic well-being of society at large. Although immediate determinants of teenage pregnancy in South Africa relate to behaviour, the fundamental drivers are more deeply rooted institutional problems of poverty, underdevelopment and gender based violence. In addition, government policies, socio-economic injustices, unequal power structures and culture contribute to the high rates of teenage pregnancies in South Africa. The aim of this study was to assess contributing to adolescent pregnancies with in three rural communities in Eastern Cape Province. Guided by the PEN-3 cultural model and Community-based participatory research principles, an explorative qualitative research design was undertaken with 14 community care workers from Glenmore, Ndwayana and Grahamstown. As phase one of an ongoing study, semi-structured interviews were carried out with the participants. The results were coded according to the domains of the PEN 3 model. The main findings indicated that adolescent pregnancies are a significant cause for concern in the communities under study. Perceptions (myths surrounding contraceptive use), enablers (availability of clinics), and nurturers (parents, peers and boyfriends) were found to be important in making decisions regarding contraceptive use and sexual activity amongst adolescents. These factors identified will inform the development of culturally sensitive and appropriate health promotion material during the next phase of the study

Hydrogen/Deuterium Exchange Mass Spectrometry Provides Insights into the Role of Drosophila Testis-Specific Myosin VI Light Chain AndroCaM

In Drosophila testis, myosin VI plays a special role, distinct from its motor function, by anchoring components to the unusual actin-based structures (cones) that are required for spermatid individualization. For this, the two calmodulin (CaM) light-chain molecules of myosin VI are replaced by androcam (ACaM), a related protein with 67% identity to CaM. Although ACaM has a similar bi-lobed structure to CaM, with two EF hand-type Ca2+ binding sites per lobe, only one functional Ca2+ binding site operates in the amino-terminus. To understand this light chain substitution, we used hydrogen–deuterium exchange mass spectrometry (HDX-MS) to examine dynamic changes in ACaM and CaM upon Ca2+ binding and interaction with the two CaM binding motifs of myosin VI (insert2 and IQ motif). HDX-MS reveals that binding of Ca2+ to ACaM destabilizes its N-lobe but stabilizes the entire C-lobe, whereas for CaM, Ca2+ binding induces a pattern of alternating stabilization/destabilization throughout. The conformation of this stable holo-C-lobe of ACaM seems to be a “prefigured” version of the conformation adopted by the holo-C-lobe of CaM for binding to insert2 and the IQ motif of myosin VI. Strikingly, the interaction of holo-ACaM with either peptide converts the holo-N-lobe to its Ca2+-free, more stable, form. Thus, ACaM in vivo should bind the myosin VI light chain sites in an apo-N-lobe/holo-C-lobe state that cannot fulfill the Ca2+-related functions of holo-CaM required for myosin VI motor assembly and activity. These findings indicate that inhibition of myosin VI motor activity is a precondition for transition to an anchoring function