Parents’ views on how health professionals should work with them now to get the best for their child in the future

Background  Pregnancy and the first years of life are important times for future child well-being. Early identification of families and children who might be likely to experience poorer outcomes could enable health professionals and parents to work together to promote each child’s well-being. Little is known about the acceptability and feasibility of such an approach to parents. Objective  To investigate parents’ views about how health professionals should identify and work with families who may benefit from additional input to maximize their children’s future health and well-being. Design  A qualitative study using focus groups. Setting and participants  Eleven focus groups were conducted with a total of 54 parents; 42 mothers and 12 fathers living in the north of England. Results  Parents welcomed the idea of preventive services. They strongly believed that everyone should have access to services to enhance child well-being whilst recognizing that some families need additional support. Making judgements about who should receive additional services based on specific criteria evoked powerful emotions because of the implication of failure. Parents projected a belief in themselves as ‘good parents’ even in adverse circumstances. Conclusions  Targeted additional preventive services can be acceptable and welcome if health professionals introduce them sensitively, in the context of an existing relationship, providing parents are active participants

Home visits by neighborhood Mentor Mothers provide timely recovery from childhood malnutrition in South Africa: results from a randomized controlled trial

Abstract Background Child and infant malnourishment is a significant and growing problem in the developing world. Malnourished children are at high risk for negative health outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve childhood nourishment. The objective of this study is to evaluate whether the Philani program can rehabilitate malnourished children in a timely manner. Methods Mentor Mothers were trained to conduct home visits. Mentor Mothers went from house to house in assigned neighborhoods, weighed children age 5 and younger, and recruited mother-child dyads where there was an underweight child. Participating dyads were assigned in a 2:1 random sequence to the Philani intervention condition (n = 536) or a control condition (n = 252). Mentor Mothers visited dyads in the intervention condition for one year, supporting mothers' problem-solving around nutrition. All children were weighed by Mentor Mothers at baseline and three, six, nine and twelve month follow-ups. Results By three months, children in the intervention condition were five times more likely to rehabilitate (reach a healthy weight for their ages) than children in the control condition. Throughout the course of the study, 43% (n = 233 of 536) of children in the intervention condition were rehabilitated while 31% (n = 78 of 252) of children in the control condition were rehabilitated. Conclusions Paraprofessional Mentor Mothers are an effective strategy for delivering home visiting programs by providing the knowledge and support necessary to change the behavior of families at risk

Maternal Cigarette Smoking during Pregnancy and Offspring Externalizing Behavioral Problems: A Propensity Score Matching Analysis

A body of empirical research has revealed that prenatal exposure to tobacco smoke is related to a host of negative outcomes, including reduced cognitive abilities, later-life health problems, and childhood behavioral problems. While these findings are often interpreted as evidence of the causal role that prenatal exposure to tobacco smoke has on human phenotypes, emerging evidence has suggested that the association between prenatal exposure to tobacco smoke and behavioral phenotypes may be spurious. The current analysis of data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) revealed that the association between prenatal exposure to cigarette smoke and externalizing behavioral problems was fully accounted for by confounding factors. The implications that these findings have for policy and research are discussed

Born in Bradford's Better Start: an experimental birth cohort study to evaluate the impact of early life interventions.

BACKGROUND: Early interventions are recognised as key to improving life chances for children and reducing inequalities in health and well-being, however there is a paucity of high quality research into the effectiveness of interventions to address childhood health and development outcomes. Planning and implementing standalone RCTs for multiple, individual interventions would be slow, cumbersome and expensive. This paper describes the protocol for an innovative experimental birth cohort: Born in Bradford's Better Start (BiBBS) that will simultaneously evaluate the impact of multiple early life interventions using efficient study designs. Better Start Bradford (BSB) has been allocated £49 million from the Big Lottery Fund to implement 22 interventions to improve outcomes for children aged 0-3 in three key areas: social and emotional development; communication and language development; and nutrition and obesity. The interventions will be implemented in three deprived and ethnically diverse inner city areas of Bradford. METHOD: The BiBBS study aims to recruit 5000 babies, their mothers and their mothers' partners over 5 years from January 2016-December 2020. Demographic and socioeconomic information, physical and mental health, lifestyle factors and biological samples will be collected during pregnancy. Parents and children will be linked to their routine health and local authority (including education) data throughout the children's lives. Their participation in BSB interventions will also be tracked. BiBBS will test interventions using the Trials within Cohorts (TwiCs) approach and other quasi-experimental designs where TwiCs are neither feasible nor ethical, to evaluate these early life interventions. The effects of single interventions, and the cumulative effects of stacked (multiple) interventions on health and social outcomes during the critical early years will be measured. DISCUSSION: The focus of the BiBBS cohort is on intervention impact rather than observation. As far as we are aware BiBBS is the world's first such experimental birth cohort study. While some risk factors for adverse health and social outcomes are increasingly well described, the solutions to tackling them remain elusive. The novel design of BiBBS can contribute much needed evidence to inform policy makers and practitioners about effective approaches to improve health and well-being for future generations

The performance of Protected Areas for biodiversity under climate change

Global environmental changes have been driving large-scale shifts in the distributions of species and in the composition of biological communities. This has thrown the continuing value of Protected Areas (PAs) into question, given that PAs remain static, whereas species move, and they are predicted to continue to move under future climate scenarios. We consider empirical evidence on the observed performance of PAs during the last 40 years of anthropogenic climate change. Despite some losses of populations and species, PAs have continued to accommodate many species, which have shifted to higher elevations, to polewards-facing aspects, and into cooler microhabitats within PAs as the climate has warmed. Even when species have declined in some PAs, they often remain more abundant inside than outside PAs. Furthermore, losses from some PAs are offset by increases in others. As species expand their ranges polewards across fragmented landscapes in response to climate warming, the majority are disproportionately colonizing PAs as they go. Hence, PA networks are acting as stepping-stones of suitable breeding conditions and facilitating range shifts, with many species remaining protected across PA networks as a whole. Finally, there is some evidence that appropriate management of PAs may be able to slow climate-related declines and accelerate expansions. The 40-year track record of species responding to environmental change in PAs suggests that networks of PAs have been essential to biodiversity conservation and are likely to continue to fulfil this role in the future. The challenge for managers will be to consider the balance between retaining current species and encouraging colonization by new species

Rhipicephalus appendiculatus ticks transmit Theileria parva from persistently infected cattle in the absence of detectable parasitemia: Implications for East Coast fever epidemiology

Abstract Background East Coast fever (ECF) is a devastating disease of cattle and a significant constraint to improvement of livestock production in sub-Saharan Africa. The protozoan parasite causing ECF, Theileria parva, undergoes obligate sexual stage development in its tick vector Rhipicephalus appendiculatus. Tick-borne acquisition and transmission occurs transstadially; larval and nymphal ticks acquire infection while feeding and transmit to cattle when they feed after molting to the next stage. Much of the current knowledge relating to tick-borne acquisition and transmission of T. parva has been derived from studies performed during acute infections where parasitemia is high. In contrast, tick-borne transmission during the low-level persistent infections characteristic of endemic transmission cycles is rarely studied. Methods Cattle were infected with one of two stocks of T. parva (Muguga or Marikebuni). Four months post-infection when parasites were no longer detectable in peripheral blood by PCR, 500 R. appendiculatus nymphs were fed to repletion on each of the cattle. After they molted to the adult stage, 20 or 200 ticks, respectively, were fed on two naïve cattle for each of the parasite stocks. After adult ticks fed to repletion, cattle were tested for T. parva infection by nested PCR and dot blot hybridization. Results Once they had molted to adults the ticks that had fed as nymphs on Muguga and Marikebuni infected cattle successfully transmitted Theileria parva to all naïve cattle, even though T. parva infection was not detectable by nested PCR on salivary gland genomic DNA of a sample of individual ticks. However, a salivary gland homogenate from a single Marikebuni infected tick was able to infect primary bovine lymphocytes. Infection was detected by nested p104 PCR in 3 of 4 calves and detected in all 4 calves by T. parva 18S nested PCR/dot blot hybridization. Conclusion We show that R. appendiculatus ticks are able to acquire T. parva parasites from infected cattle even in the absence of detectable parasitemia. Although infection was undetectable in a sample of individual ticks, cumulatively as few as 20 ticks were able to transmit T. parva to naïve cattle. These results have important implications for our understanding of T. parva transmission by R. appendiculatus in ECF endemic regions