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Effectiveness of a pre-adolescent inter-generational intervention to address HIV and obesity in South Africa, using a pretest-posttest design.

ABSTRACT: Strengthening pre-adolescents knowledge and skills through an age- and culturally-appropriate intervention could prevent health issues later in life. Early interventions could influence the trajectory of future risky behaviour, and may influence health behaviour amongst their parents. The CIrCLE of Life Initiative was developed to address HIV and obesity. We evaluated whether the combined intervention increased knowledge, enhanced skills, and/or promoted healthy behaviour among students (9-12 years old) and their parents. The study was conducted from May to December 2018. Trained educators delivered 30-min lessons over ten consecutive weeks with 537 Grade 6 students at five government-run schools, in a district, in South Africa. Schools were purposively selected based on socioeconomic status and urban-rural classification. Students communicated with parents through shared homework activities. A pretest-posttest study design was used, with a 3-month follow up. Both groups completed self-administered paper-based questionnaires. A score of subscales was used in analysis. The pretest and posttest scores were compared for students and parents using a dependent t-test. Differences in outcomes by school quintile were compared using one-way ANOVA. Response rates were high for both students (80.6%) and their parents (83.4%). Statistically significant differences were observed in HIV knowledge in students pretest (mean 8.04, SD 3.10) and posttest scores (mean 10.1, SD 2.70; p < 0.01), and their parents (mean 10.32, SD 2.80 vs 11.0, SD 2.50; p < 0.01). For both students and parents, pre- and post-test obesity awareness mean scores were similar, 1.93, SD 0.92 and 2.78, SD 0.57; p < 0.01, for students; and 2.47, SD 0.82 and 2.81, SD 0.54; p < 0.01, for parents. In the posttest, statistically significant changes were also observed in both groups, enhancing skills in measuring body mass index and pulse rate, and interpreting food labels. Students had a high intention to share gained knowledge with parents who had a high intention to receive it (89.4 and 89.5%, respectively). The intervention increased knowledge about HIV and obesity-related awareness, and it enhanced skills in selected outcomes among pre-adolescents and parents. Accurate messages and enhanced communication skills could support inter-generational knowledge transfer. ClinicalTrials.gov Identifier: NCT04307966 retrospectively registered on 12 March 2020.

SUBMITTER: Arthur K

PROVIDER: S-EPMC8665511 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Organisational readiness is an implementation pre-requisite to gain its members' appropriate and committed use of the intervention. Implementation climate and organisational readiness for implementing change were evaluated conjointly to assess organisational readiness for an obesity and HIV health intervention that imparts health information directly to Grade 6 learners, and indirectly to their parents/caregivers in their home environment. The study objectives were to assess the level of organisational readiness at schools and to identify organisational factors (facilitators, barriers and contextual factors). A mixed-methods approach collected data from five public schools in Gauteng, South Africa. Forty-six educators and school management answered a self-administered questionnaire and contributed to a focus group discussion at each school. Mean scores with standard deviations, or median scores with interquartile ranges, were calculated to determine levels of organisational readiness. Qualitative data were transcribed and analysed thematically. The overall implementation climate and organisational readiness for implementing change median scores were acceptable, at 3.6 (IQR 3.2-4.1) and 4.3 (IQR 3.8-4.9), respectively. Results indicated that educators collectively valued the change highly enough to commit to its implementation, and that the motivation for the intervention, associated goals and objectives, the realisation for change, and the benefits thereof were well-comprehended by educators. Thirteen barriers and 13 facilitators were identified. The perceived degree of fit between the significance and values attached to the intervention by educators, and how these would be received by the target group (parents and learners) was also beneficial. Key barriers and facilitators indicated that the intervention needed to be a fit with existing workflows and educational systems. Contextual factors such as intervention appropriateness and acceptability as well as sensitivity to HIV were identified. These findings suggested proactive improvements to further improve the intervention and its implementation strategy.

Project description:BACKGROUND/OBJECTIVES:Acylcarnitines, intermediates of fatty acid oxidation, are known to be involved in obesity and insulin resistance. Since maternal prepregnancy overweight or obesity (OWO) is a recognized major risk factor for offspring OWO, we hypothesized that maternal plasma acylcarnitines may play a role in inter-generational OWO. SUBJECTS/METHODS:This study included 1402 mother-child pairs (1043 term, 359 preterm) recruited at birth from 1998-2013 and followed prospectively up to age 18 years at the Boston Medical Center. The primary outcomes were child OWO defined as BMI???85th percentile for age and sex. The primary exposures were maternal prepregnancy OWO defined as BMI???25 kg/m2 and maternal acylcarnitine levels measured in plasma samples collected soon after delivery using liquid chromatography-tandem mass spectrometry (LC-MS) in a targeted manner. RESULTS:Approximately 40% of the children in this study were OWO by age 5. Maternal OWO had a significant association with childhood OWO, both in term and preterm births. ?-hydroxybutyryl-carnitine (C4-OH) levels were significantly and positively associated with child OWO among term births after adjustment for potential confounders and multiple-comparisons. Children born to OWO mothers in the top tertile C4-OH levels were at the highest risk of OWO: OR?=?3.78 (95%CI: 2.47, 5.79) as compared with those born to non-OWO mothers in the lowest tertile (P for interaction of maternal OWO and C4-OH?=?0.035). In a four-way decomposition of mediation/interaction analysis, we estimated that C4-OH levels explained about 27% (se?=?0.08) of inter-generational OWO risk (P?=?0.001). In contrast, these associations were not observed in preterm births. CONCLUSIONS:In this U.S. urban low-income birth cohort, we provide further evidence of the inter-generational link of OWO and reveal the differential role of C4-OH in explaining the inter-generational obesity between term and preterm births. Further investigations are warranted to better understand and prevent the inter-generational transmission of OWO.

Project description:BackgroundSocial distancing measures to address the US coronavirus disease 2019 (COVID-19) epidemic may have notable health and social impacts.Methods and findingsWe conducted a longitudinal pretest-posttest comparison group study to estimate the change in COVID-19 case growth before versus after implementation of statewide social distancing measures in the US. The primary exposure was time before (14 days prior to, and through 3 days after) versus after (beginning 4 days after, to up to 21 days after) implementation of the first statewide social distancing measures. Statewide restrictions on internal movement were examined as a secondary exposure. The primary outcome was the COVID-19 case growth rate. The secondary outcome was the COVID-19-attributed mortality growth rate. All states initiated social distancing measures between March 10 and March 25, 2020. The mean daily COVID-19 case growth rate decreased beginning 4 days after implementation of the first statewide social distancing measures, by 0.9% per day (95% CI -1.4% to -0.4%; P < 0.001). We did not observe a statistically significant difference in the mean daily case growth rate before versus after implementation of statewide restrictions on internal movement (0.1% per day; 95% CI -0.04% to 0.3%; P = 0.14), but there is substantial difficulty in disentangling the unique associations with statewide restrictions on internal movement from the unique associations with the first social distancing measures. Beginning 7 days after social distancing, the COVID-19-attributed mortality growth rate decreased by 2.0% per day (95% CI -3.0% to -0.9%; P < 0.001). Our analysis is susceptible to potential bias resulting from the aggregate nature of the ecological data, potential confounding by contemporaneous changes (e.g., increases in testing), and potential underestimation of social distancing due to spillover effects from neighboring states.ConclusionsStatewide social distancing measures were associated with a decrease in the COVID-19 case growth rate that was statistically significant. Statewide social distancing measures were also associated with a decrease in the COVID-19-attributed mortality growth rate beginning 7 days after implementation, although this decrease was no longer statistically significant by 10 days.

Project description:UnlabelledImprovement in prosthetic training using intermanual transfer (the transfer of motor skills from the trained, “unaffected” hand to the untrained, “affected” hand) has been shown in previous studies. The aim of this study is to determine the influence of the inter-training interval on the magnitude of the intermanual transfer effects. This was done using a mechanistic, randomized, single-blinded pretest-posttest design. Sixty-four able-bodied, right-handed participants were randomly assigned to the Short and Long Interval Training Groups and the Short and Long Interval Control Groups. The Short and Long Interval Training Groups used a prosthesis simulator in their training program. The Short and Long Interval Control Groups executed a sham training program, that is, a dummy training program in which the same muscles were trained as with the prosthesis simulator. The Short Interval Training Group and the Short Interval Control Groups trained on consecutive days, while the Long Interval Training Group and Long Interval Control Group trained twice a week. To determine the improvement in skills, a test was administered before, immediately after, and at two points in time after the training. Training was performed with the “unaffected” arm; tests were performed with the “affected” arm. The outcome measurements were: the movement time (the time from the beginning of the movement until completion of the task); the duration of maximum hand opening, (the opening of the prosthetic hand while grasping an object); and the grip-force control (the error from the required grip-force during a tracking task). Intermanual transfer was found in movement times, but not in hand opening or grip-force control. The length of the inter-training interval did not affect the magnitude of intermanual transfer effects. No difference in the intermanual transfer effect in upper-limb prosthesis training was found for training on a daily basis as compared to training twice a week.Trial registrationNederlands Trial Register NTR3888.

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Effectiveness of a pre-adolescent inter-generational intervention to address HIV and obesity in South Africa, using a pretest-posttest design.

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