GESTATIONAL WEIGHT GAIN AND THE RISK OF OBESITY AMONG PRESCHOOL CHILDREN: IS THIS MEDIATED THROUGH BIRTH WEIGHT?

Data from the 2001 Early Childhood Longitudinal Study Birth- Cohort were used to examine the association between maternal gestational weight gain (GWG) and the risk of obesity in the offspring, and the possible mediating role of birth weight. The Centers for Disease Control growth 2000 reference charts and child\u27s height and weight measured at age 4 or 5 years old were used to determine child body mass index (BMI) Z-scores or obesity status (greater than or equal to the 95th percentile). Multiple linear or logistic regression models were used to adjust for maternal age, race, education, smoking status and prepregnancy BMI. In this population (unweighted n=6400), 43.4% of mothers exceeded the 2009 Institute of Medicine (IOM) weight gain recommendation, while 30.2% gained weight below the recommendation. 17.6% of children were obese. We found that a 1 kg increase in the weekly rate of GWG in the second and third trimesters was associated with 0.37-unit increase in BMI Z-score (95% CI: 0.14-0.61), and 2.31 times higher odds of being obese (95% CI: 1.51-3.54). Gaining weight exceeding IOM recommendations was positively associated with a 0.14 unit increase child BMI Z-scores compared to gaining adequate GWG (95% CI: 0.01-0.26). In a subsample of offspring who were born full term (unweighted n=5400), a 5-kilogram increase in total GWG was also associated with 0.07 unit increase in BMI Z-scores (95% CI: 0.02-0.26) and 1.19 times the odds of being obese (95% CI: 1.08-1.30). Mediation analysis was conducted to decompose the total effects into direct and indirect effects. There were stronger direct effects than indirect effects. Birth weight is a moderate mediator between the association of maternal GWG and offspring and weight status. In conclusion, targeting maternal GWG is a promising approach to prevent childhood obesity

Fostering institutional existentialism in the search for legitimacy

Educational and training institutions functioning in today’s globalized economic landscape find themselves in a situation where they face competition but also interrelatedness and interdependency with other global institutions. This naturally drives these institutions towards the pursuit of legitimacy, which would see its qualifications (and by extension its students) recognized as equal to its/their compeers. Within the field of organizational communication management, a body of literature focuses in on this pursuit of legitimacy, and frames it within an institutional mindset; formally as within institutional theory. Institutional theory, however, when practiced in educational organizations, has the potential to be functionalistic in nature – isolating and manipulating organizational elements to work towards achieving a desired state. In this paper, the institutional mindset of educators and students at the University of South Africa is empirically explored, in order to unpick the functionalistic nature thereof and to suggest alternative ways in which to interpret and implement institutionalism within this context. Herein, the four pillars of institutionalism is conceptually and empirically discussed, offering up considerations as to a more existentialistic approach in their effecting. From this, this paper proposes ways in which institutional existentialism has the potential to balance the perception of globalized legitimacy with contextual validity and authenticity

Disclosure of HIV status to sexual partners by people living with HIV

Background: Disclosure of one’s HIV status to a sexual partner can have significant health implications. From a health promotion point of view, disclosure is seen as a cornerstone for the prevention of HIV transmission between partners. Despite its importance as a strategy for controlling the spread of HIV, there are challenges that inhibit voluntary disclosure. Objectives: In exploring factors associated with disclosure of HIV status, the study had two complementary objectives related to: (1) investigation of participants’ views about HIVpositive status disclosure to sexual partners; and (2) a broader identification of factors that influence disclosure of HIV-positive status. Method: The study explored factors associated with disclosure of the HIV status of people living with HIV to their sexual partners. Purposive sampling was used to select 13 participants living with HIV who attended a wellness clinic. Primary data were collected via an in-depth interview with each of the participants. Results: The exploration showed that male participants were notably more reluctant to disclose to their sexual partners for fear of rejection; and secrecy was commonly reported around sexual matters. Female participants (who were in the majority) were relatively more willing to disclose their HIV status to their sexual partners. Despite the complexity of disclosure, all participants understood the importance of disclosure to their sexual partners. Conclusion: There is a need for HIV prevention strategies to focus on men in particular, so as to strengthen disclosure counselling services provided to people living with HIV and to advocate strongly for partner testing.Health Studie

Mental health service users' experiences of mental health care: an integrative literature review.

The aim of this integrative literature review was to identify mental health service users' experiences of services. The rationale for this review was based on the growing emphasis and requirements for health services to deliver care and support, which recognizes the preferences of individuals. Contemporary models of mental health care strive to promote inclusion and empowerment. This review seeks to add to our current understanding of how service users experience care and support in order to determine to what extent the principles of contemporary models of mental health care are embedded in practice. A robust search of Web of Science, the Cochrane Database, Science Direct, EBSCO host (Academic Search Complete, MEDLINE, CINAHL Plus Full-Text), PsycINFO, PsycARTICLES, Social Sciences Full Text and the United Kingdom and Ireland Reference Centre for data published between 1 January 2008 and 31 December 2012 was completed. The initial search retrieved 272609 papers. The authors used a staged approach and the application of predetermined inclusion/exclusion criteria, thus the numbers of papers for inclusion were reduced to 34. Data extraction, quality assessment and thematic analysis were completed for the included studies. Satisfaction with the mental health service was moderately good. However, accessing services could be difficult because of a lack of knowledge and the stigma surrounding mental health. Large surveys document moderate satisfaction ratings; however, feelings of fear regarding how services function and the lack of treatment choice remain. The main finding from this review is while people may express satisfaction with mental health services, there are still issues around three main themes: acknowledging a mental health problem and seeking help; building relationship through participation and care; and working towards continuity of care. Elements of the recovery model appear to be lacking in relation to user involvement, empowerment and decision making. There is a need for a fundamental shift in the context of the provider-service user relationship to fully facilitate service users' engagement in their care

Online or not? A comparison of students’ experiences of an online and an on-campus class

Educational discourse has long portrayed online, or e-based, learning and all non-campus-based learning options as second best to traditional face-to-face options. Critically much of the research and debate in this area of study has focused on evidence relating to student performance, attrition and retention with little consideration of the total learning experience, which values both the traditional learning outcome measures side-by-side with student-centered factors, such as students’ satisfaction with their learning experience. The objective of this study was to present a synchronous head-to-head comparison between online and campus-based students’ experiences of an undergraduate course. This paper reports on a qualitative comparative cross-sectional study, which used multiple data collection approaches to assess student learning and student satisfaction of 61 students who completed a semester of an undergraduate course. Of the 61 students, 34 were enrolled purely as online students, whilst the remaining 27 students studied the same material entirely through the traditional face-to-face medium. Methods included a standardised student satisfaction survey and an ‘achievement of learning outcomes’ measurement tool. Students on the online cohort performed better in areas where ‘self-direction’ in learning was indicated, for example self-directed problem-based tasks within the course. Online students gave less positive self-assessments of their perceived content mastery than their campus-based counterparts, despite performing just as well in both summative and formative assignments. A multi-factorial comparison shows online students to have comparable educational success and that, in terms of student satisfaction, online learners reported more satisfaction with their learning experience than their campus-based counterparts

Female perspectives of male partners’ inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal

Background: The South African government intervened by implementing the prevention of mother–to-child transmission programme (PMTCT) to curb the HIV transmission from mother to child during and after pregnancy. The PMTCT programme has been at the forefront of global prevention efforts since 1998. Without treatment, the risk of transmission ranges from one in five to one in two newborns; however, the risk of mother-to-child transmission can be reduced to as low as 2%–5% with evidenced interventions. Sub-Saharan Africa, and most particularly South Africa, is the most affected by the pandemic despite having the largest financial investment in PMTCT services across the continent. Objectives: The objectives of the study were to describe and explore the female perspectives of male inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal. Methodology: A qualitative, descriptive, explorative study was conducted through in-depth individual interview of pregnant women until data saturation. Results: The findings of the study revealed that the existing design of public hospitals was not wholly conducive to facilitating male inclusion in maternal and child health services. Resources were largely insufficient to support the participation of pregnant mothers and any attempts to support the inclusion of males needed to be based on a clear increase in service provision. Conclusion: The study recommended male partners’ inclusion in the prevention of mother- to-child HIV transmission to support effective management of HIV in pregnancy and PMTCT programmes. The inclusion of men will provide the holistic support needed by pregnant women on PMTCT programmes

Emergency contraception amongst female college students – knowledge, attitude and practice

Background: Unwanted teenage pregnancies have a notable detrimental impact on the learners’ trajectory and have been associated with jeopardising the students’ educational progress and future career prospects. These pregnancies are mostly unplanned and unintended and many are terminated, either legally or illegally. Aim: The aim of this study was to explore the contributory role played by the knowledge, attitude and practices of female college students with respect to the utilisation of emergency contraceptives. Setting: Three tertiary institutions in Dessie, Ethiopia. Methods: Quantitative self-administered questionnaires were used to collect descriptive data from 352 female college students. Results: The study revealed that there was a high percentage (78.3%) of unwanted pregnancies amongst those engaging in sex. Significantly, nearly half (43.3%) of these unwanted pregnancies resulted in abortion. Only 10% of the students sampled admitted to ever having used emergency contraception. Even though more than half (69.9%) of the students knew about emergency contraception, only 27% of them felt confident that they understood when it was most effective. Conclusion: These and other observed findings confirm the need for improvement of female college students’ knowledge and timely utilisation of emergency contraception

Where is my Daddy? An Exploration of the Impact of Absentee Fathers on the Lives of Young People in Botswana

A substantial body of research has consistently concluded that children growing up with absentee fathers are at an increased risk of maladjustment. This paper argues that co-parenting can have both direct and indirect or mediated effects on children. Co-parenting has an added benefit of modelling dyadic skills that include proving mutual emotional support, influence, and amicable resolution of disputes. Through qualitative data obtained in 2009 from 45 final year students at the University of Botswana, the authors conclude that African personhood is a larger-than-self conception, which also includes more than the physical being and shows that young people raised in father-absent familiesview their personhood as inferior, less guarded, and incomplete, relative to that of their counterparts who were born and raised in married-couple families. Living a full quality life eludes youth who were raised by mothers only, affirming the importance of fathers in the personhood of any individual.Key Words: Absentee fathers; youth personhood; co-parentin

Comparing EMR Fall Risk Calculation to Performance-based Assessments

Falls are the second leading cause of accidental or unintentional injury deaths worldwide. Many factors contribute to an increased risk of falling, such as age, disease state, and medication use. The purpose of the current investigation was to compare an electronic medical record (EMR) fall risk calculator, the theoretical Timed Up and Go (T-TUG), which utilizes gender, age, BMI, and prescription and OTC drug counts as variables, to other established performance- and paper-based assessments of fall risk. The National Social Life, Health, and Aging Project (NSHAP) Database was used to develop the T-TUG. Data was analyzed from participants in Wave 1 of the Irish Longitudinal Study on Ageing (TILDA) to validate the T-TUG. Performance-based assessments included mean grip force for both dominant and nondominant hands, Timed Up and Go (TUG), and a paper-based assessment titled the Steadiness Index. The latter is a series of 3 questions assessing steadiness when walking, standing, or getting up from a chair. Those participants of the TILDA cohort passing the inclusion criteria were divided into those who reported a fall in the previous year (N=1159) and those reporting no falls (N=4746). Two group comparisons were analyzed by Mann-Whitney U Test (p\u3c0.05) and a Receiver Operator Characteristics (ROC) curve analysis was used to detect separation of fall and non-fall groups. For the Mann-Whitney U test the fall and no fall groups were statistically different for the T-TUG (p\u3c0.001), TUG (p\u3c0.001), dominant and nondominant grip forces (p\u3c0.001), and the steadiness index (p\u3c 0.001). In the fall group, the grip forces were weaker, T-TUG and TUG time longer, and the steadiness index scores lower. For the grip force assessments and steadiness index, lower scores are more likely to be associated with a higher fall risk. In the T-TUG and TUG, longer times are more likely to be associated with a higher fall risk. In the ROC curve analyses, the T-TUG (0.567, p\u3c0.001) demonstrated similar outcomes compared to dominant (AUC=547, p\u3c0.09) and non-dominant (AUC=0.550, p\u3c0.01) grip forces, and the TUG (AUC=0.558, p\u3c0.001). The steadiness index ROC analysis was slightly better than the T-TUG (AUC=0.579, p\u3c0.001). Sensitivity (52-58%) and specificity (50-57%) ranges were equivalent for all performance-based assessments, whereas for the Steadiness Index, the sensitivity (40%) was lower than the specificity (75%). The EMR fall-risk calculator (T-TUG) is a valid triage tool to estimate fall risk in older community dwellers. The EMR calculator has the potential for real-time assessment of patients using current data compared to other performance- and paper-based assessments, which would allow the healthcare team to spend more time with higher fall risk patients