Maternal infection during pregnancy is known to alter the development and function of offspring's immune system, leading to inappropriate immune responses to common childhood infections and ...immunizations. Although this is an expanding field, maternal parasitic infections remain understudied. Millions of women of reproductive age are currently at risk for parasitic infection, whereas many pregnant, chronically infected women are excluded from mass drug administration due partially to a lack of resources, as well as fear of unknown adverse fetal developmental outcomes. In areas endemic for multiple parasitic infections, such as sub-Saharan Africa, there are increased rates of morbidity and mortality for various infections during early childhood in comparison with nonendemic areas. Despite evidence supporting similar immunomodulatory effects between various parasite species, there is no clear mechanistic understanding of how maternal infection reprograms offspring immunity. This brief review will compare the effects of selected maternal parasitic infections on offspring immunity.
Background
The World Health Organization's (WHO’s) Health Promoting Schools (HPS) framework is an holistic, settings‐based approach to promoting health and educational attainment in school. The ...effectiveness of this approach has not been previously rigorously reviewed.
Objectives
To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well‐being of students and their academic achievement.
Search methods
We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB s, IBSS, Social Science Citation Index, Sociological s, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles.
Selection criteria
We included cluster‐randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school’s ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements.
Data collection and analysis
At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random‐effects meta‐analyses to provide a summary of results across studies.
Main results
We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand‐washing (2), multiple risk behaviours (7), cycle‐helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self‐reported data and high attrition rates for some studies. In addition, there was a lack of long‐term follow‐up data for most studies.
We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta‐analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school‐related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement.
Authors' conclusions
The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well‐designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
Healthy children achieve better educational outcomes which, in turn, are associated with improved health later in life. The World Health Organization's Health Promoting Schools (HPS) framework is a ...holistic approach to promoting health and educational attainment in school. The effectiveness of this approach has not yet been rigorously reviewed.
We searched 20 health, education and social science databases, and trials registries and relevant websites in 2011 and 2013. We included cluster randomised controlled trials. Participants were children and young people aged four to 18 years attending schools/colleges. HPS interventions had to include the following three elements: input into the curriculum; changes to the school's ethos or environment; and engagement with families and/or local communities. Two reviewers identified relevant trials, extracted data and assessed risk of bias. We grouped studies according to the health topic(s) targeted. Where data permitted, we performed random-effects meta-analyses.
We identified 67 eligible trials tackling a range of health issues. Few studies included any academic/attendance outcomes. We found positive average intervention effects for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small. On average across studies, we found little evidence of effectiveness for zBMI (BMI, standardized for age and gender), and no evidence for fat intake, alcohol use, drug use, mental health, violence and bullying others. It was not possible to meta-analyse data on other health outcomes due to lack of data. Methodological limitations were identified including reliance on self-reported data, lack of long-term follow-up, and high attrition rates.
This Cochrane review has found the WHO HPS framework is effective at improving some aspects of student health. The effects are small but potentially important at a population level.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Sports participation can confer a range of physical and psychosocial benefits and, for refugee and migrant youth, may even act as a critical mediator for achieving positive settlement and engaging ...meaningfully in Australian society. This group has low participation rates however, with identified barriers including costs; discrimination and a lack of cultural sensitivity in sporting environments; lack of knowledge of mainstream sports services on the part of refugee-background settlers; inadequate access to transport; culturally determined gender norms; and family attitudes. Organisations in various sectors have devised programs and strategies for addressing these participation barriers. In many cases however, these responses appear to be ad hoc and under-theorised. This article reports findings from a qualitative exploratory study conducted in a range of settings to examine the benefits, challenges and shortcomings associated with different participation models. Interview participants were drawn from non-government organisations, local governments, schools, and sports clubs. Three distinct models of participation were identified, including short term programs for refugee-background children; ongoing programs for refugee-background children and youth; and integration into mainstream clubs. These models are discussed in terms of their relative challenges and benefits and their capacity to promote sustainable engagement and social inclusion for this population group.
A specific foundation of knowledge is important for evaluating potential abuse from physical findings in the older adult. The standard physical examination is a foundation for detecting many types of ...abuse. An understanding of traumatic injuries, including patterns of injury, is important for health care providers, and inclusion of elder abuse in the differential diagnosis of patient care is essential. One must possess the skills needed to piece the history, including functional capabilities, and physical findings together. Armed with this skill set, health care providers will develop the confidence needed to identify and intervene in cases of elder abuse.
Disasters are an important public health issue; however, there is scarce evidence to date on what happens when communities and populations experience more than one disaster. This scoping review ...identifies literature on the effects of multiple disasters published until Aug 2, 2021, 1425 articles were identified, of which 150 articles were included. We analysed direct and indirect public health implications of multiple disasters. Our analysis suggests that exposure to multiple disasters can affect mental health, physical health, and wellbeing, with some evidence that the potential risks of multiple disaster exposure exceed those of single disaster exposure. We also identified indirect public health implications of multiple disaster exposure, related to changes in health-care facilities, changes in public risk perception, and governmental responses to multiple disasters. We present findings on community recovery and methodological challenges to the study of multiple disasters, and directions for future research.
Ethical complexities associated with research involving vulnerable and marginalized population groups are well recognized, while practical solutions to these challenges are somewhat less well ...described. In this article we focus on strategies for addressing interrelated practical, methodological and ethical issues which may arise during research with refugee-background participants considered vulnerable. The article draws on a study exploring the impact of social networks and support on the resettlement experiences of newly-arrived migrant youth of refugee background in Australia. Three key sets of issues are discussed: developing research processes that maximize the benefits of involvement for participants while reducing potential harms; enhancing capacities for participants to give informed consent; and adapting research methods to heighten their relevance to the circumstances of participants’ lives and enhance their engagement in the research. We argue that promoting ethical practice and methodological validity are mutually reinforcing objectives and illustrate how processes of ethical reflexivity were applied to resolve methodological challenges, promote autonomy and capacity of research participants and enhance the potential for outcomes to be rigorous and useful.
To outline the importance of the clarity of data analysis in the doing and reporting of interview‐based qualitative research.
We explore the clear links between data analysis and evidence. We argue ...that transparency in the data analysis process is integral to determining the evidence that is generated. Data analysis must occur concurrently with data collection and comprises an ongoing process of ‘testing the fit’ between the data collected and analysis. We discuss four steps in the process of thematic data analysis: immersion, coding, categorising and generation of themes.
Rigorous and systematic analysis of qualitative data is integral to the production of high‐quality research. Studies that give an explicit account of the data analysis process provide insights into how conclusions are reached while studies that explain themes anchored to data and theory produce the strongest evidence.
Objective:Although disasters are a major cause of mental health problems and typically affect large numbers of people and communities, little is known about how social structures affect mental health ...after a disaster. The authors assessed the extent to which mental health outcomes after disaster are associated with social network structures.Method:In a community-based cohort study of survivors of a major bushfire disaster, participants (N=558) were assessed for probable posttraumatic stress disorder (PTSD) and probable depression. Social networks were assessed by asking participants to nominate people with whom they felt personally close. These nominations were used to construct a social network map that showed each participant’s ties to other participants they nominated and also to other participants who nominated them. This map was then analyzed for prevailing patterns of mental health outcomes.Results:Depression risk was higher for participants who reported fewer social connections, were connected to other depressed people, or were connected to people who had left their community. PTSD risk was higher if fewer people reported being connected with the participant, if those who felt close to the participant had higher levels of property loss, or if the participant was linked to others who were themselves not interconnected. Interestingly, being connected to other people who in turn were reciprocally close to each other was associated with a lower risk of PTSD.Conclusions:These findings provide the first evidence of disorder-specific patterns in relation to one’s social connections after disaster. Depression appears to co-occur in linked individuals, whereas PTSD risk is increased with social fragmentation. These patterns underscore the need to adopt a sociocentric perspective of postdisaster mental health in order to better understand the potential for societal interventions in the wake of disaster.
To evaluate the immediate and sustained effectiveness of the first Jamie's Ministry of Food Program in Australia on individuals' cooking confidence and positive cooking/eating behaviours.
A quasi- ...experimental repeated measures design was used incorporating a wait-list control group. A questionnaire was developed and administered at baseline (T1), immediately post program (T2) and 6 months post completion (T3) for participants allocated to the intervention group, while wait -list controls completed it 10 weeks prior to program commencement (T1) and just before program commencement (T2). The questionnaire measured: participants' confidence to cook, the frequency of cooking from basic ingredients, and consumption of vegetables, vegetables with the main meal, fruit, ready-made meals and takeaway. Analysis used a linear mixed model approach for repeated measures using all available data to determine mean differences within and between groups over time.
All adult participants (≥18 years) who registered and subsequently participated in the program in Ipswich, Queensland, between late November 2011- December 2013, were invited to participate.
In the intervention group: 694 completed T1, 383 completed T1 and T2 and 214 completed T1, T2 and T3 assessments. In the wait-list group: 237 completed T1 and 149 completed T1 and T2 assessments. Statistically significant increases within the intervention group (P<0.001) and significant group*time interaction effects (P<0.001) were found in all cooking confidence measures between T1 and T2 as well as cooking from basic ingredients, frequency of eating vegetables with the main meal and daily vegetable intake (0.52 serves/day increase). Statistically significant increases at T2 were sustained at 6 months post program in the intervention group.
Jamie's Ministry of Food Program, Australia improved individuals' cooking confidence and cooking/eating behaviours contributing to a healthier diet and is a promising community-based strategy to influence diet quality.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
