Theoretical adequacy, methodological quality and efficacy of online interventions targeting resilience: a systematic review and meta-analysis

Background There is a growing interest in the promotion of mental health, and concepts as resilience are re-emerging and taking relevance. In addition, Information and Communication Technologies can provide potential benefits in the field of mental health, and the treatment of mental disorders in particular. This study aims to synthesize the evidence of internet-based resilience interventions, analyzing the theoretical adequacy, methodological quality and efficacy. Methods A systematic search was performed. The eligibility criteria stated for this article were: randomized controlled trials targeted at adults or adolescents and including any psychological intervention focussing on resilience in its rationale or design. Studies with direct (e.g. resilience scales) and proximal resilience measures (e.g. scales on well-being) were included. Risk of bias was assessed for each trial using Cochrane’s Collaboration Tool. Two reviewers worked independently in order to identify potential articles. A total of 11 articles were selected. A random-effects pooling model using the Hartung–Knapp–Sidik–Jonkman method based on direct and proximal resilience measures at post-test was used. Results The overall effects of online resilience training compared to control groups at post-test were not significant; the effect size concerning the improvement of resilience was g=0.12 (95% CI: −0.14 to 0.38). In addition, a potential association between the type of outcome and the effect size could be revealed. Conclusions The results of the present meta-analysis showed that the overall effect of online resilience trainings was not significant. Nonetheless, a tendency for a higher benefit for resilience was found in the studies with a clear assessment theory, indicating some promising effects

Interventions to reduce gender-based violence among young people living with or affected by HIV/AIDS in low-income and middle-income countries

Objective(s): This study explored the effectiveness of gender-based violence (GBV) interventions on young people living with or affected by HIV in low- and middle-income countries (LMICs). Design: Systematic review and meta-analysis. Methods: We pre-registered a protocol, then searched thirteen databases and grey literature. We screened randomised and quasi-experimental studies (n = 2199) of young people (aged 10–24) living with or affected by HIV in LMICs. Outcomes were GBV and/or GBV-related attitudes. We appraised the data for risk of bias and quality of evidence. Narrative syntheses and multi-level random effects meta-analyses were conducted. Results: We included 18 studies evaluating 21 interventions. Intervention arms were categorised as: a) sexual health and social empowerment (SHSE) (n = 7); b) SHSE plus economic strengthening (n = 4); c) self-defence (n = 3); d) safer schools (n = 2); e) economic strengthening only (n = 2); f) GBV sensitisation (n = 2) and g) safer schools plus parenting (n = 1). Risk of bias was moderate/high and quality of evidence low. Narrative syntheses indicated promising effects on GBV exposure, but no or mixed effects on GBV perpetration and attitudes for self-defence and GBV sensitisation interventions. Safer schools interventions showed no effects. For SHSE interventions and SHSE plus economic strengthening, meta-analysis showed a small reduction in GBV exposure but not perpetration. Economic-only interventions had no overall effect. Conclusions: SHSE, SHSE plus and self-defence and gender sensitisation interventions may be effective for GBV exposure and GBV-related attitudes but not for GBV perpetration. However, the quality of evidence is poor. Future intervention research must include both boys and girls, adolescents living with HIV and key populations.</p

Parenting for lifelong health:A pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa

Objective To assess the impact of ‘Parenting for Lifelong Health: Sinovuyo Teen’, a parenting programme for adolescents in low- and middle-income countries, on abuse and parenting practices. Design Pragmatic cluster randomised control trial. Setting 40 villages/urban sites (clusters) in the Eastern Cape province, South Africa. Participants 552 families reporting conflict with their adolescents (aged 10-18). Intervention Intervention clusters (n=20) received a 14-session parent and adolescent programme delivered by trained community members. Control clusters (n=20) received a hygiene and hand-washing promotion programme. Main outcome measures Primary outcomes: abuse and parenting practices at one and 5-9 months post-intervention. Secondary outcomes: Caregiver and adolescent mental health and substance use, adolescent behavioural problems, social support, exposure to community violence, and family financial wellbeing at 5-9 months post-intervention. Blinding was not possible. Results At 5-9 months post-intervention, the intervention was associated with lower abuse (caregiver report incidence rate ratio (IRR) 0.55 (95% CI 0.40 to 0.75, p Conclusions This parenting programme shows promise for reducing violence, improving parenting and family functioning in low-resource settings.</p

Inhibition of ATG3 ameliorates liver steatosis by increasing mitochondrial function

Non-alcoholic fatty liver disease (NAFLD) is a major health threat in both developed and developing countries and is a precursor of the more advanced liver diseases, including non-alcoholic steatohepatitis (NASH), cirrhosis, and liver cancer. Currently, understanding the multiple and complex molecular pathways implicated in NAFLD onset and progression is a major priority. The transcription factor p63, which belongs to a family comprising p53, p63, and p73,1 is one of many factors that contributes to the development of liver steatosis. The role of p63 as a tumor suppressor and in cell maintenance and renewal is well studied, but we have recently reported that it is also relevant in the control of lipid metabolism.2 p63 encodes multiple isoforms that can be grouped into 2 categories; isoforms with an acidic transactivation domain (TA) and those without this domain (domain negative). The TAp63α isoform is elevated in the liver of animal models of NAFLD as well as in liver biopsies from obese patients with NAFLD. Furthermore, downregulation of p63α in the liver attenuates liver steatosis in diet-induced obese (DIO) mice, while the activation of TAp63α increases hepatic fat content, mediated by the activation of IKKβ and endoplasmic reticulum stress.2 A specialized form of autophagy that degrades lipid droplets, termed “lipophagy”, is a major pathway of lipid mobilization in hepatocytes. Lipophagy is elevated in hepatoma cells upon exposure to free fatty acids,3 and reduces the fatty acid load in mouse hepatocytes.4 Its impairment has been associated with the development of fatty liver and insulin resistance3,5; in contrast, the autophagic flux is increased during the activation of hepatic stellate cells.6 In the present study, we used an unbiased proteomics approach to gain insight into novel proteins modulating lipid metabolism in the liver of mice with genetic knockdown or overexpression of TAp63α. We found that autophagy-related gene 3 (ATG3) was upregulated by TAp63α activation and downregulated after p63α inhibition. ATG3 is elevated in several animal models of NAFLD and in the liver of patients with NAFLD. Genetic overexpression of ATG3 increased the lipid load in hepatocytes, while its repression alleviated TAp63α- and diet-induced steatosis. ATG3 exerted its role in lipid metabolism by regulating SIRT1 and mitochondrial function. Collectively, these findings identify ATG3 as a novel factor implicated in the development of steatosisThis work has been supported by grants from FEDER/Ministerio de Ciencia, Innovación y Universidades-Agencia Estatal de Investigación (PA: RTI2018-095134-B-100; DS and LH: SAF2017-83813-C3-1-R; MLMC: RTC2019-007125-1; CD: BFU2017-87721; ML: RTI2018–101840-B-I00; GS; PID2019-104399RB-I00; RN: RTI2018-099413-B-I00 and RED2018-102379-T; MLMC: SAF2017-87301-R; TCD: RTI2018-096759-A-100), FEDER/Instituto de Salud Carlos III (AGR: PI19/00123), Xunta de Galicia (ML: 2016-PG068; RN: 2015-CP080 and 2016-PG057), Fundación BBVA (RN, GS and MLM), Proyectos Investigación en Salud (MLMC: DTS20/00138), Sistema Universitario Vasco (PA: IT971-16); Fundación Atresmedia (ML and RN), Fundación La Caixa (M.L., R.N. and M.C.), Gilead Sciences International Research Scholars Program in Liver Disease (MVR), Marató TV3 Foundation (DS: 201627), Government of Catalonia (DS: 2017SGR278) and European Foundation for the Study of Diabetes (RN and GS). This research also received funding from the European Community’s H2020 Framework Programme (ERC Synergy Grant-2019-WATCH- 810331, to RN, VP and MS). Centro de Investigación Biomédica en Red (CIBER) de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Hepáticas y Digestivas (CIBERehd) and CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERdem). CIBERobn, CIBERehd and CIBERdem are initiatives of the Instituto de Salud Carlos III (ISCIII) of Spain which is supported by FEDER funds. We thank MINECO for the Severo Ochoa Excellence Accreditation to CIC bioGUNE (SEV-2016-0644)S

A parenting programme to prevent abuse of adolescents in South Africa:Study protocol for a randomised controlled trial

An estimated one billion children experience child abuse each year, with the highest rates in low- and middle-income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence-prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting and reduce adolescent behavioural problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme.This is a pragmatic cluster randomised controlled trial, with stratified randomisation of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavioural problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3-8 months post-intervention. A 15-24-month follow-up is planned, but this will depend on the financial and practical feasibility given delays related to high levels of ongoing civil and political violence in the research sites.This is the first known trial of a parenting programme to prevent abuse of adolescents in a low- or middle-income country. The study will also examine potential mediating pathways and moderating factors. Pan-African Clinical Trials Registry PACTR201507001119966

Reducing child abuse amongst adolescents in low- and middle-income countries:A pre-post trial in South Africa

Background: No known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. ‘Parenting for Lifelong Health’ (http://tiny.cc/whoPLH) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. Research aims of this first pre-post trial in South Africa were: i) to identify indicative effects of the programme on child abuse and related outcomes; ii) to investigate programme safety for testing in a future randomised trial, and iii) to identify potential adaptations. Methods: 230 participants (adolescents and their primary caregivers) were recruited from schools, welfare services and community-sampling in rural, high-poverty South Africa (no exclusion criteria). All participated in a 12-week parenting programme, implemented by local NGO childcare workers to ensure real-world external validity. Standardised pre-post measures with adolescents and caregivers were used, and paired t-tests were conducted for primary outcomes: abuse (physical, emotional and neglect), adolescent behaviour problems and parenting (positive and involved parenting, poor monitoring and inconsistent discipline), and secondary outcomes: mental health, social support and substance use. Results: Participants reported high levels of socio-economic deprivation, e.g. 60% of adolescents had either an HIV-positive caregiver or were orphaned by AIDS, and 50% of caregivers experienced intimate partner violence. i) indicative effects: Primary outcomes comparing pre-test and post-test assessments showed reductions reported by adolescents and caregivers in child abuse (adolescent report 63.0% pre-test to 29.5% post-test, caregiver report 75.5% pre-test to 36.5% post-test, both p&lt;0.001) poor monitoring/inconsistent discipline (p&lt;.001), adolescent delinquency/ aggressive behaviour (both p&lt;.001), and improvements in positive/involved parenting (p&lt;.01 adolescent report, p&lt;.001 caregiver report). Secondary outcomes showed improved social support (p&lt;.001 adolescent and caregiver reports), reduced parental and adolescent depression (both p&lt;.001), parenting stress (p&lt;.001 caregiver report) and caregiver substance use (p&lt;.002 caregiver report). There were no changes in adolescent substance use. No negative effects were detected. ii) Programme acceptability and attendance was high. There was unanticipated programme diffusion within some study villages, with families initiating parenting groups in churches, and diffusion through school assemblies and religious sermons. iii) potential adaptations identified included the need to strengthen components on adolescent substance use and to consider how to support spontaneous programme diffusion with fidelity. Conclusions: The programme showed no signs of harm and initial evidence of reductions in child abuse and improved caregiver and adolescent outcomes. It showed high acceptability and unexpected community-level diffusion. Findings indicate needs for adaptations, and suitability for the next research step of more rigorous testing in randomised trials, using cluster randomization to allow for diffusion effects

Violence, socioeconomic disadvantage and interpersonal protective factors for adolescents’ resilience in education in the Eastern Cape, South Africa

Background: many adolescents from socioeconomically disadvantaged communities in South Africa are exposed to multiple types of violence at home, in school and in their communities. To date, little is known in this context about the effects of this violence on the adolescents’ educational outcomes, nor is much known about the protective factors contributing to adolescents’ resilience in education. In order to partially address this gap in knowledge, this DPhil thesis generates evidence using self-report data from a purposive sample of 503 adolescents aged 10 to 18. Adolescents came from 40 socioeconomically disadvantaged communities and were participating in a child-abuse prevention trial in the Eastern Cape Province. Aims: This DPhil thesis has two aims. First, this thesis examines the effects of self-report past-month exposure to violence and socioeconomic disadvantage on adolescents’ school delay and academic motivation (Study/Paper 1). Second, following a socioecological resilience approach, this thesis then investigates parents and teachers as two potential sources of resilience in education (Studies/Papers 2 and 3 respectively). Methods and results: Study 1: Paper 1 applied Latent Profile Analysis (LPA) to examine relationships between past-month exposure to violence, school delay and academic motivation. In the sample of 503 adolescents, 93.8% experienced ‘poly-violence’ – exposure to at least two forms of violence in the past month. Results identified two distinct profiles in this socioeconomically disadvantaged sample: Profile 1, adolescents exposed to more-frequent ‘poly-violence’, and Profile 2, adolescents exposed to less-frequent ‘poly-violence’. Being exposed to more-frequent ‘poly-violence’ was associated with greater risk of school delay – based on age-appropriate grades in South Africa. However, being exposed to more-frequent ‘poly-violence’ was not associated with lower academic motivation: adolescents still showed high rates of wanting to achieve. Study 2: Paper 2 applied an aggregated multilevel Structural Equation Model (SEM) in order to investigate the potential of supportive parenting in protecting against adolescents’ school delay. Adolescents’ self-report data on child abuse in the family, school and community, and adolescents’ perceptions of positive parenting, consistent discipline, good monitoring, parental involvement and social support were analyzed. Results showed that perceptions of more-positive parenting and consistent discipline significantly moderated the relationship between more-frequent exposure to multiple forms of violence and school delay; while none of the five parenting factors included in the model were directly and significantly associated with school delay. Results indicated that supportive parenting practices cannot completely compensate against the strong negative effects of exposure to violence and socioeconomic disadvantage on adolescents’ school delay. However, adolescents exposed to more-frequent ‘poly-violence’ and receiving positive parenting and consistent discipline from their parents are less likely to be behind the appropriate grade for their age. Study 3: Paper 3 applied an aggregated multilevel Structural Equation Model (SEM) in order to investigate the potential for teachers’ academic and emotional support to protect against adolescents’ school delay. Adolescents’ self-report data on child abuse in the family, school and community, and adolescents’ perceptions of teacher emotional and academic support were analyzed. Results suggested that being exposed to more-frequent ‘poly-violence’ and receiving more emotional support from teachers were both independently associated with greater school delay (p&amp;LT;0.05). On the contrary, higher academic support from teachers was associated with lower school delay (p&amp;LT;0.01). However, neither the academic nor emotional support from teachers – as perceived by students – significantly moderated the relationship between more-frequent exposure to ‘poly-violence’ and adolescents’ school delay. This means that academic support provided by teachers can help to mitigate the likelihood of school delay for all adolescents living in disadvantaged communities in South Africa. However, teacher academic support does not translate into an extra ‘boost’ for those who have experienced more-frequent ‘poly-violence’. Overall findings: Exposure to more-frequent ‘poly-violence’ increases the risk of school delay for adolescents from disadvantaged communities in South Africa, though it does not reduce their academic motivation. Thus, whilst adolescents maintain aspirations and goals to do well at school, frequent exposure to violence impacts their capacity to fulfil these aims. Further, the findings from this study suggest that supportive parenting has the potential to partially protect against school delay for more-frequent poly-victimized adolescents in South Africa, which suggests resilience processes for education are at play in the home lives of these adolescents. This is contextualized by the findings that teacher academic support is an important factor for school success for all adolescents living in these communities – whether they are exposed to more-frequent ‘poly-violence’ or not. However, the level of teacher academic support within the poorly-resourced schools that these children attended was found to be quite low (on average). Policy considerations: Three main policy considerations are suggested by these findings. First, results suggest that in order to improve the educational outcomes of at-risk adolescents in South Africa, interventions aiming at reducing exposure to violence are urgently needed (Study 1). Second, results also showed the potential benefit of targeted interventions that promote positive parenting and consistent parental discipline amongst the most vulnerable families with adolescents exposed to more-frequent ‘poly-violence’ (Study 2). Third, school-based secondary intervention programs that assist teachers to provide greater academic support in deprived contexts - characterized by adolescents being frequently exposed to violence – have the potential to lessen the occurrence of school delay (Study 3).</p

Exposure to violence, teacher support, and school delay amongst adolescents in South Africa

BackgroundMany adolescents in South Africa are exposed to multiple types of violence, socio-economic disadvantage, and low-quality education: all risk factors for educational outcomes including school delay (grade enrolment below that which is age-appropriate). Supportive teacher–student relationships are known to be associated with improved academic outcomes in high-income contexts.AimsTo investigate whether the academic and emotional support provided by teachers can protect against school delay for adolescents exposed to multiple types of violence and socio-economic disadvantage in South Africa.SampleHigh-risk sample of 503 adolescents aged 10–18 exposed to multiple types of violence and socio-economic disadvantage at home, in school, and in their communities.MethodsMultilevel aggregated structural equation modelling was applied to pre/post-RCT data. This investigated whether associations between adolescent exposure to violence and school delay could be lessened by having teachers who were academically and/or emotionally supportive.ResultsMore frequent exposure to ‘poly-violence’ and receiving more emotional support from teachers were independently associated with greater school delay. On the contrary, higher academic support from teachers was associated with lower school delay. Neither academic nor emotional teacher support was found to moderate the relationship between more frequent exposure to ‘poly-violence’ and an increased risk of adolescent school delay.ConclusionAdolescents’ academic support from teachers is low in poorly resourced school contexts in South Africa. School-based secondary prevention programmes assisting teachers with more training and academic support in deprived contexts have potential to reduce the impact of violence and socio-economic disadvantage on adolescents’ school delay

Can supportive parenting protect against school delay amongst violence-exposed adolescents in South Africa?

Exposure to multiple forms of violence is common amongst adolescents from socioeconomically disadvantaged communities in South Africa. Adolescents’ exposure to violence at home, in school and in their communities can lead to detrimental outcomes in education. In particular, adolescents who are more frequently exposed to multiple forms of violence are at risk of school delay. This paper investigates the potential for supportive parenting to protect against adolescents’ school delay in this context. With this aim, this paper applies structural equation modelling to a sample of 503 adolescents exposed to multiple forms of violence from 40 socioeconomically disadvantaged communities. Adolescents’ self-report data on child abuse in the family, school and community, and adolescents’ perceptions of positive parenting, consistent discipline, good monitoring, parental involvement and social support were analyzed. Results showed that perceptions of more positive parenting and consistent discipline moderated the relationship between more frequent exposure to multiple forms of violence and school delay. Our findings suggest that supportive parenting has the potential to protect against school delay for poly-victimized adolescents in South Africa

Disadvantaged adolescents and educational delay in South Africa: Impacts of personal, family and school characteristics

No quantitative studies to date have specifically focused on the risk and protective factors for the educational resilience of socioeconomically disadvantaged adolescents who are not of compulsory school age in South Africa. This study compares the educational delay of 599 black adolescents aged 16 to 18 from socioeconomically disadvantaged communities in Western Cape and Mpumalanga to nationally and provincially representative estimates in South Africa. The paper also explores predictors for educational delay by comparing out-of-school adolescents (n = 64), and adolescents who are at least one year behind in school (n = 380), with adolescents in the age-appropriate grade or higher (n = 155). Risk factors for being behind included the following: male gender, past grade repetition, rural location and larger school size. Risk factors for being out of school were the following: past grade repetition, previous concentration problems at school, household poverty, and food insecurity. Protective factors for being in the age-appropriate grade included the following: living with biological caregivers, access to school counselling and attending schools in wealthier communities