Family-centred interventions by primary healthcare services for Indigenous early childhood wellbeing in Australia, Canada, New Zealand and the United States: a systematic scoping review

© 2017 The Author(s).Background: Primary healthcare services in Australia, Canada, New Zealand and the United States have embraced the concept of family-centred care as a promising approach to supporting and caring for the health of young Indigenous children and their families. This scoping review assesses the quality of the evidence base and identifies the published literature on family- centred interventions for Indigenous early childhood wellbeing. Methods: Fourteen electronic databases, grey literature sources and the reference lists of Indigenous maternal and child health reviews were searched to identify relevant publications from 2000 to 2015. Studies were included if the intervention was: 1) focussed on Indigenous children aged from conception to 5 years from the abovementioned countries; 2) led by a primary healthcare service; 3) described or evaluated; and 4) scored greater than 50% against a validated scale for family-centredness. The study characteristics were extracted and quality rated. Reported aims, strategies, enablers and outcomes of family-centredcare were identified using grounded theory methods. Results: Eighteen studies (reported in 25 publications) were included. Three were randomised controlled studies; most were qualitative and exploratory in design. More than half of the publications were published from 2012 to 2015. The overarching aim of interventions was to promote healthy families. Six key strategies were to: support family behaviours and self- care, increase maternal knowledge, strengthen links with the clinic, build the Indigenous workforce, promote cultural/ community connectedness and advocate for social determinants of health. Four enablers were: competent and compassionate program deliverers, flexibility of access, continuity and integration of healthcare, and culturally supportive care. Health outcomes were reported for Indigenous children (nutritional status; emotional/behavioural; and prevention of injury and illness); parents/caregivers (depression and substance abuse; and parenting knowledge, confidence and skills); health services (satisfaction; access, utilization and cost) and community/cultural revitalisation. Discussion and conclusion: The evidence for family-centred interventions is in the early stages of development, but suggests promise for generating diverse healthcare outcomes for Indigenous children and their parents/caregivers, as well as satisfaction with and utilisation of healthcare, and community/cultural revitalisation. Further research pertaining to the role of fathers in family-centred care, and the effects and costs of interventions is needed

Potently neutralizing and protective human antibodies against SARS-CoV-2

The COVID-19 pandemic is a major threat to global health1 for which there are limited medical countermeasures2,3. Moreover, we currently lack a thorough understanding of mechanisms of humoral immunity4. From a larger panel of human monoclonal antibodies (mAbs) targeting the spike (S) glycoprotein5, we identified several that exhibited potent neutralizing activity and fully blocked the receptor-binding domain of S (SRBD) from interacting with human ACE2 (hACE2). Competition-binding, structural, and functional studies allowed clustering of the mAbs into classes recognizing distinct epitopes on the SRBD as well as distinct conformational states of the S trimer. Potent neutralizing mAbs recognizing non-overlapping sites, COV2-2196 and COV2-2130, bound simultaneously to S and synergistically neutralized authentic SARS-CoV-2 virus. In two mouse models of SARS-CoV-2 infection, passive transfer of either COV2-2196 or COV2-2130 alone or a combination of both mAbs protected mice from weight loss and reduced viral burden and inflammation in the lung. In addition, passive transfer of each of two of the most potently ACE2 blocking mAbs (COV2-2196 or COV2-2381) as monotherapy protected rhesus macaques from SARS-CoV-2 infection. These results identify protective epitopes on SRBD and provide a structure-based framework for rational vaccine design and the selection of robust immunotherapeutics

The Effects of Parent-Implemented Language Interventions on Child Linguistic Outcomes: A Meta-Analysis

Intervening early is important to minimize persistent difficulties in language and related domains in young children with or at-risk for language impairment (LI; Rescorla, 2009). Because language is first learned in caregiver–child interactions, parent-implemented interventions are potentially an important early intervention for children with or at-risk for LI. Previous meta-analyses have examined outcomes of parent-implemented interventions for children with primary and secondary LI, but have not included children at-risk for LI due to low SES. A systematic review of the literature identified 25 randomized controlled trials of parent-implemented language interventions examining linguistic outcomes for young children. Studies included 1734 participants (M = 3.7 years) with or at-risk for LI due to low SES. Results of these meta-analyses indicated modest improvements in expressive vocabulary and small improvements in expressive language for children with or at-risk for LI. The effect size for expressive vocabulary outcomes was significant for shared book reading interventions (g = 0.37, 95% CI [0.15–0.59]) and interventions implemented in play and/or routines (g = 0.50, 95% CI [0.05–0.95]). The effect size for expressive language was significant (g = 0.42, 95% CI [0.19–0.65]), but not for receptive language (g = 0.07, ns), and the effect size for receptive vocabulary was not significant (g = 0.18, ns). Sub-group analyses for expressive vocabulary and expressive language indicated moderate to large significant effects for children with or at-risk for primary LI and smaller, non-significant effects for children with Autism Spectrum Disorder. Findings are generally consistent with a previous meta-analysis (Roberts and Kaiser, 2011), indicating parent-implemented language interventions may have positive effects on linguistic outcomes for young children with or at-risk for LI. Limited measures of parent training procedures and varied measures of parent outcomes limited the analysis of how child outcomes were achieved