Experiences of obesity among Saudi Arabian women contemplating bariatric surgery: An interpretative phenomenological analysis

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2013 The Authors.This study explored experiences of obesity, its perceived causes and motives for surgery, as described by seven Saudi women contemplating bariatric surgery. The women experienced cultural restrictions on their physical and social activities. Obesity embodied these restrictions, attracting stigma and moral failure. Traditional clothing, foods, hospitality norms and limited outdoor female activities were regarded as barriers to weight loss. Bariatric surgery was chosen to protect health and to access normative female roles. Some were encouraged by relatives who had undergone surgery. Opting for surgery reflected both participants’ sense of powerlessness to self-manage weight and the social acceptability, within their family context, of this biomedical approach

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

Predictors of Stunting, Wasting and Underweight among Tanzanian Children Born to HIV-Infected Women.

Children born to human immunodeficiency virus (HIV)-infected women are susceptible to undernutrition, but modifiable risk factors and the time course of the development of undernutrition have not been well characterized. The objective of this study was to identify maternal, socioeconomic and child characteristics that are associated with stunting, wasting and underweight among Tanzanian children born to HIV-infected mothers, followed from 6 weeks of age for 24 months. Maternal and socioeconomic characteristics were recorded during pregnancy, data pertaining to the infant's birth were collected immediately after delivery, morbidity histories and anthropometric measurements were performed monthly. Multivariate Cox proportional hazards methods were used to assess the association between potential predictors and the time to first episode of stunting, wasting and underweight. A total of 2387 infants (54.0% male) were enrolled and followed for a median duration of 21.2 months. The respective prevalence of prematurity (<37 weeks) and low birth weight (<2500 g) was 15.2% and 7.0%; 11.3% of infants were HIV-positive at 6 weeks. Median time to first episode of stunting, wasting and underweight was 8.7, 7.2 and 7.0 months, respectively. Low maternal education, few household possessions, low infant birth weight, child HIV infection and male sex were all independent predictors of stunting, wasting and underweight. In addition, preterm infants were more likely to become wasted and underweight, whereas those with a low Apgar score at birth were more likely to become stunted. Interventions to improve maternal education and nutritional status, reduce mother-to-child transmission of HIV, and increase birth weight may lower the risk of undernutrition among children born to HIV-infected women

Detecting virological failure in HIV-infected Tanzanian children

Background. The performance of clinical and immunological criteria to predict virological failure in HIV-infected children receiving antiretroviral therapy (ART) is not well documented.Objective. To determine the validity of clinical and immunological monitoring in detecting virological failure in children on ART.Methods. A total of 218 children were included in the study. All were from care and treatment clinics in Dar es Salaam, Tanzania. Their mean age was 10.6 years, 122 (56.0%) were males, and the mean time on ART was 40.9 months. The study was conducted from August 2011 to March 2012. Data on sociodemographic and clinical characteristics and immunological and virological failure were based on World Health Organization definitions. Blood samples were collected for CD4+ T-cell count and viral load tests.Results. Of 217 children with available viral load results, 124 (57.1%) had virological failure (&gt;400 copies/mL), 25.0% immunological failure and 11.5% clinical failure. The sensitivity, specificity, positive predictive value and negative predictive value of clinical criteria were 12.9%, 90.3%, 64.0% and 43.8%, respectively, those for immunological criteria 22.6%, 73.1%, 53.3% and 41.4%, and those for the combination of clinical and immunological monitoring 25.8%, 69.9%, 53.3% and 41.4%. Children who received nevirapine (NVP)-based regimens were two times more likely (odds ratio 2.0; 95% confidence interval 1.20 - 3.64) to have virological failure than those on efavirenz and protease inhibitor-based regimens. Conclusions. The study demonstrated poor performance of currently recommended clinical and immunological criteria for monitoring HIV-infected children on ART. Moreover, children on NVP-based regimens had a higher risk of developing virological failure than those on other regimens

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

Do Tanzanian hospitals need healthcare ethics committees? Report on the 2014 Dartmouth/Penn Research Ethics Training and Program Development for Tanzania (DPRET) workshop

Ethical issues are common in the global community. The shortage of human and medical resources when working with vulnerable populations requires institutional support to address the challenges that often arise in the patient-provider relationship. The 2014 Dartmouth/Penn Research Ethics Training and Program Development for Tanzania (DPRET) workshop centred on discussions about research and clinical ethics issues unique to Tanzanian healthcare providers. This article discusses some of the ethical challenges that workshop participants reported in their day-to-day work life with patients and families, such as truth-telling, disagreements over treatment plans and patient distrust of local physicians and hospital staff, among others. The Tanzanian participants recognised the need for supportive mechanisms within their local hospital environments. Further dialogue and research on the development of institutional ethics committees within hospital systems is critically needed so that healthcare providers can meet their ethical and professional obligations to patients and families and address ethical conflicts that arise in a timely and productive fashion

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

Brownian Simulations and Uni-Directional Flux in Diffusion

Brownian dynamics simulations require the connection of a small discrete simulation volume to large baths that are maintained at fixed concentrations and voltages. The continuum baths are connected to the simulation through interfaces, located in the baths sufficiently far from the channel. Average boundary concentrations have to be maintained at their values in the baths by injecting and removing particles at the interfaces. The particles injected into the simulation volume represent a unidirectional diffusion flux, while the outgoing particles represent the unidirectional flux in the opposite direction. The classical diffusion equation defines net diffusion flux, but not unidirectional fluxes. The stochastic formulation of classical diffusion in terms of the Wiener process leads to a Wiener path integral, which can split the net flux into unidirectional fluxes. These unidirectional fluxes are infinite, though the net flux is finite and agrees with classical theory. We find that the infinite unidirectional flux is an artifact caused by replacing the Langevin dynamics with its Smoluchowski approximation, which is classical diffusion. The Smoluchowski approximation fails on time scales shorter than the relaxation time $1/\gamma$ of the Langevin equation. We find the unidirectional flux (source strength) needed to maintain average boundary concentrations in a manner consistent with the physics of Brownian particles. This unidirectional flux is proportional to the concentration and inversely proportional to $\sqrt{\Delta t}$ to leading order. We develop a BD simulation that maintains fixed average boundary concentrations in a manner consistent with the actual physics of the interface and without creating spurious boundary layers