Minimally invasive versus transcatheter closure of secundum atrial septal defects: a systematic review and meta-analysis.

BACKGROUND: Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to transcatheter (TC) closure of atrial septal defects (ASD). This systematic review and meta-analysis aims to compare post-operative outcomes of MIS versus TC repair in ASD closure. METHODS: PubMed, Medline and EMBASE were searched from inception until June 2018 for randomised and observational studies comparing post-operative outcomes for MIS and TC repair. The studies were reviewed for bias using the ROBINS-I Score and pooled in a meta-analysis using STATA (version 15). RESULTS: Six observational studies, involving 1524 patients assessing three primary and five secondary outcomes were included. Evidence suggests TC repair yielded shorter hospital stay (MD = 3.32, 95% CI 1.04-5.60) and lower rates of transient atrial fibrillation (AF) (RR = 0.48, 95% CI 0.20-1.15). TC repair patients also had fewer pericardial effusions (RR = 0.27, 95% CI 0.05-1.54, I2 = 0.0%) and pneumothoraxes (RR = 0.18, 95% CI 0.04-0.80, I2 = 0.0%). However, TC repair results in more minor residual shunts (RR = 6.04, 95% CI 1.69-21.63 in favour of MIS, I2 = 39.0%). No differences were found for incidences of strokes (RR = 1.58, 95% CI 0.23-10.91, I2 = 19.3%), unexpected bleeding (RR = 0.44, 95% CI 0.19-1.04, I2 = 0.0%) and blood transfusion (RR = 0.39, 95% CI 0.09-1.59, I2 = 0.0%). CONCLUSIONS: MIS closure for ASD has similar outcomes compared to TC repair. However, the lack of randomised literature related to MIS versus TC repair for ASD closure warrants further evidence in the form of RCTs to further support these findings.

"I have HIV but I'm not the HIV" - the experiences of heterosexual Chinese men living with HIV in Singapore.

As HIV is widely acknowledged as a stigmatized chronic condition which impacts the self, it is important to study the experiences of people living with HIV in relation to their selves and identities. According to extant literature on HIV and identity, the incorporation of an HIV identity is essential to adapting to the diagnosis. However, most of the participants in this study reject HIV as an identity. Using qualitative in-depth interviews, this paper explores the experiences of twelve heterosexual Chinese men living with HIV in Singapore. This paper is anchored by identity concepts from identity theory to examine the impact of HIV on self and identities and how various identities are reworked in the face of a stigmatized chronic medical condition. Thematic analysis shows varying impact of HIV on self, the role of normative identities and the location of HIV in their lives. The findings shed light on the importance of normative identities and the manner in which participants locate HIV in their lives.

Factors influencing paternal involvement during infancy: A prospective longitudinal study.

AIMS: To explore factors influencing paternal involvement at 6 months postpartum and to detail the trend of these factors over a period of 6 months. BACKGROUND: There is a dearth of studies on paternal involvement during infancy in the unique Asian context. DESIGN: A prospective four-time point longitudinal design was adopted. METHODS: A total of 201 participants were recruited from a local hospital from May 2016 - December 2017 using convenience sampling. Self-administered questionnaires were used for data collection. Data were statistically analysed. RESULTS: Parenting self-efficacy at 6-month postpartum, paternal involvement, and paternal postnatal depression on the day of wife's hospital discharge, wife in paid work and wife's antenatal class attendance significantly influenced paternal involvement at 6 months postpartum. A sub-analysis of first-time and experienced fathers revealed that parenting self-efficacy at 6-month postpartum, paternal involvement on the day of wife's hospital discharge and wife in paid work were significant factors influencing paternal involvement for first-time fathers. Significant factors influencing paternal involvement for experienced fathers were paternal involvement on the day of wife's hospital discharge and wife's antenatal class attendance. CONCLUSION: Fathers (first-time and experienced) who were involved during their infant's birth were also involved at 6-month postpartum. Healthcare professionals may encourage paternal involvement through teaching fathers infant care skills during the antenatal period, especially first-time fathers as they may be lacking in such skills, which may hinder their parenting satisfaction. Paternal involvement throughout the perinatal period can be enforced by healthcare professionals to promote paternal involvement.

Dynamics of ADHD in familial contexts: perspectives from children and parents and implications for practitioners.

This article provides in-depth insights on the bidirectional dynamics between parents and their children with attention deficit hyperactivity disorder (ADHD). Five family units (8 parents, 5 children, N = 13) participated in this study. Parents and their child with ADHD were interviewed individually in their homes. Stressful moments of parent-child dynamics revolved around managing their child's behavior and doing homework. Findings highlight the child's agency and power of influence, and the possible recovery of negative dynamics. It is recommended that practitioners adopt the strengths perspective in working with these families and incorporate child's agency and bidirectional dynamics in interventions.

Reconstruction of Soft-Tissue Defects of the Thumb Using Reverse-Flow Homodigital Flaps: A Systematic Review.

Introduction: Soft-tissue thumb defects are common reconstructive challenges, the main goals being restoration of tactile sensibility, range of movement, pulp padding, length, and cosmesis. The reverse-flow dorsoulnar and dorsoradial collateral artery flaps are homodigital flaps used to cover both distal dorsal and volar thumb defects. These flaps can be used as compound flaps including skin, fat, and/or nerves. As there is no critical analysis of these studies, this study aims to create a synthesized comprehensive systematic review. Methods: Systematic review was performed using the databases PubMed, Embase, and Medline. Eligible studies followed the inclusion criteria: English language and all studies published to date. The primary outcome was flap survival. Other data collected included anatomical area of the defect, flap constituents and dimensions, donor-site closure and complications, transfer method, reoperation, revision, and functional outcomes. Results: A total of 19 articles incorporating 189 flaps met the inclusion criteria. These flaps were categorized and analyzed as dorsoradial (50%), dorsoulnar (39%), and turnover flaps (11%). Dorsoradial flaps were used in fasciocutaneous fashion alone. Partial flap failures occurred in five cases. Dorsoulnar flaps were used as fasciocutaneous or as osteocutaneous flaps. Complete flap failure was reported in one patient alone, whereas partial necrosis was reported in four patients. Adipofascial turnover flaps had two partial flap failures reported but no complete failures. The overall complete and partial flap failure rates were 0.5 and 6.5%, respectively. Conclusion: Reverse-flow homodigital random or axial-based flaps provide a reliable means of reconstruction for soft-tissue defects with reasonable success rate and good functional outcomes. They have a consistent anatomy with a good potential for personalization and therefore increased versatility.

Changes in attitudes towards telemedicine in acute burn care following the Covid-19 pandemic.

BACKGROUND: Telemedical referrals after burn injury had been shown to be advantageous over telephone referrals for multiple reasons, however there were several key barriers towards complete implementation. The Covid-19 pandemic facilitated the adoption of telemedicine to ensure the safety of both clinicians and patients. Due to the circumstances, it was unclear whether the pre-pandemic barriers still existed despite the complete implementation of telemedicine. This study aims to evaluate clinicians' views about the barriers towards implementation of a specific telemedicine system for burns referrals, and their changing attitudes following the pandemic, to identify key domains for improvement in current and future telemedicine systems. METHODS: A questionnaire was created to evaluate the attitudes of referring clinicians towards telemedicine, following literature searches and administration of a pilot questionnaire. This was administered via telephone to staff working in EDs and MIUs which referred to the South-West United Kingdom Burns Network using the Medical Data Solutions and Services (MDSAS) system, in both 2019 and 2022. A statistical analysis was performed to compare the attitudes of clinicians towards telemedicine both pre- and post-pandemic. RESULTS: 100 respondents completed the survey in 2019 and 70 in 2022, with similar demographics of respondents. Out of the twelve barriers identified, the lack of reliable Wi-Fi and need to duplicate notes were identified as the main obstacles to implementation in both time periods. In both years, the single greatest barrier reported was poor access to reliable Wi-Fi (p = 0.944). Miscommunication between clinicians using the system, inadequate numbers of devices and financial constraints were identified less frequently as barriers in 2022 than 2019 (p = 0.005, p = 0.047 and p < 0.001 respectively). However, significantly more respondents reported time pressures when waiting for a response to their telemedicine referral in 2022 (p = 0.022). CONCLUSION: Overall, clinicians displayed a positive attitude towards the MDSAS system for acute burns, with clinicians identifying fewer concerns with the system following the Covid-19 pandemic. However, concerns over the time pressures that this telemedicine system places on the referring clinician and existing Wi-Fi infrastructure persist. Further streamlining of the system and investment in internet access is recommended, with continued input from all stakeholders.

Re-Engineering Data Processing Workflow to Automate Abbreviations Audit of Clinical Documentation.

In KK Women's and Children's Hospital (KKH), clinical case notes audits are conducted quarterly for compliance of approved acronym usage. Existing process involves the retrieval of mixed hardcopy and electronic case notes for referencing manually to the list of approved abbreviations by clinical coder. Through the use of process re-engineering and excel application, audit coverage can thus be expanded with reduction in human dependency and errors with significant resultant savings in time spent.

Reliability and concurrent validity of Four Square Step Test scores in subjects with chronic stroke: a pilot study.

OBJECTIVES: To establish (1) the intrarater and interrater reliability of Four Square Step Test (FSST) times in persons with chronic stroke; (2) the concurrent validity of FSST times with standing balance and functional mobility measures; and (3) the FSST cutoff score for distinguishing the differences in dynamic balance performance of persons with chronic stroke from healthy control adults. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center. PARTICIPANTS: Convenience sample of subjects (N=30) consisting of community-dwelling persons with chronic stroke (n=15) and healthy control adults (n=15). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FSST scores; balance and functional mobility measured using Berg Balance Scale (BBS) scores; Timed Up & Go (TUG) test scores; and limits of stability (LOS) measured by dynamic posturography. RESULTS: FSST times showed good intrarater reliability, with intraclass correlation coefficients ranging from .82 to .83 and an interrater reliability >.99. An FSST cutoff score of 11 seconds was able to discriminate between healthy adults older than 50 years and persons with stroke (sensitivity, 73.3%; specificity, 93.3%). FSST times were correlated with LOS scores for directional control in the backward direction (r=.64; P=.01). FSST was approaching a significant correlation with TUG scores (r=.59; P=.02) and LOS scores for endpoint excursion in the forward direction (r=-.58; P=.02). However, there was no correlation with BBS scores. CONCLUSION: FSST is an easy-to-administer clinical test with good intrarater and interrater reliability in persons with chronic stroke to assess dynamic standing balance. FSST times of 11 seconds are able to differentiate between persons with chronic stroke and healthy adults older than 50 years. The correlation of FSST times with standing balance and functional mobility measures requires further research with a larger sample size.

Assessing the effectiveness and implementation of a universal classroom-based set of educator practices to improve preschool children's social-emotional outcomes: Protocol for a cluster randomized controlled type 2 hybrid trial in Singapore.

BACKGROUND: Providing high-quality early childhood care and education is understood as key to maximizing children's potential to succeed later in life, as it stimulates young children's development of skills and competencies needed to promote optimal outcomes and success later in life. Despite the government's efforts to support the early childhood sector, educators in Singapore continue to report difficulties in implementing practices in classrooms that promote children's social, emotional, and cognitive development. To enhance educators' skills in these domains, we developed the Enhancing And Supporting Early development to better children's Lives (EASEL) Approach, a set of universal, educator-delivered practices for use with 3-6-year-old children in early childhood settings to improve social, emotional, behavioral, and executive functioning (SEB+EF) outcomes. METHODS: This study will evaluate the effectiveness and implementation of the EASEL Approach in improving early childhood educators' teaching practices and, in turn, children's SEB+EF outcomes. We will conduct a cluster randomized controlled trial with a type 2 hybrid effectiveness-implementation study in 16 childcare centers. The EPIS (Explore, Prepare, Implement, Sustain) Framework will be used to inform the implementation of the EASEL Approach. Implementation strategies include training, educator self-assessments, practice-based coaching, and data monitoring. Our primary outcome is educators' teaching practices. Secondary outcomes include educators' adoption of the EASEL Approach in everyday practice, the acceptability and feasibility of the EASEL Approach, and children's SEB+EF outcomes. Quantitative and qualitative data will be collected at baseline, six months, and after implementation. CONCLUSION: Findings from this study will provide significant evidence on the effectiveness of the EASEL Approach in improving educators' teaching practices and its impact on children's SEB+EF outcomes and the implementation of the EASEL Approach in early childhood classrooms in Singapore. TRIAL REGISTRATION: This study was prospectively registered on ClinicalTrials.gov, Identifier: NCT05445947 on 6th July 2022.

Reliability and validity of step test scores in subjects with chronic stroke.

OBJECTIVES: To establish (1) the intrarater and interrater reliabilities of step test (ST) scores in subjects with chronic stroke, (2) the ST's known-groups validity and cutoff scores for distinguishing subjects with chronic stroke from healthy adults older than 50 years, and (3) the convergent validity of ST scores with lower-limb muscle strength, coordination, balance performance, and walking speed. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center. PARTICIPANTS: Convenience sample of subjects (N=30): community-dwelling subjects with chronic stroke (n=15) and healthy adults older than 50 years (n=15). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: ST scores; handheld dynamometer measurements of bilateral lower-limb muscle strength; lower-extremity motor coordination test (LEMOCOT) scores; Berg Balance Scale scores; walking speed as measured by a 5-meter walk test. RESULTS: ST scores showed excellent intrarater reliability, with intraclass correlation coefficients ranging from .981 to .995 and interrater reliability ranging from .996 to .999. A cutoff score of 13 on the paretic side was found to distinguish the healthy adults older than 50 years from subjects with stroke at a sensitivity of 87% and a specificity of 87%. A cutoff score of 11 on the nonparetic side was found to distinguish the healthy adults from subjects with stroke at a sensitivity of 100% and a specificity of 67%. ST scores of the paretic limb demonstrated a significant correlation with muscle strength, the LEMOCOT scores of the paretic leg, and walking speed. ST scores of the nonparetic limb demonstrated a significant correlation with muscle strength and the LEMOCOT scores of the paretic leg. CONCLUSIONS: The ST is a reliable measurement tool when the number of steps is counted by either experienced or inexperienced examiners by viewing videotapes. ST scores with both the paretic limb and the nonparetic limb are sensitive in distinguishing subjects with chronic stroke from healthy adults older than 50 years.

Predictors of maternal distress among mothers in economic hardship: A classification and regression tree analysis (CART).

A recurrent observation in poverty research is the association between many attendant stress factors and the high incidence of maternal distress. In this study, we reason that such risk factors do not preclude mothers from possessing adaptive capacities, through perceived parenting efficacy and family hardiness, as buffers against two common distress sources in low socioeconomic status (SES) households-perceived children's emotional and behavioral problems, and family's economic hardship. Using classification and regression tree analysis, we examined the moderating roles of these maternal factors in emotional distress with 513 Singaporean mothers of elementary school-age children on government financial scheme. The study affirmed that this low-resource population is not homogeneous in their perceived levels of distress and adaptive resources. These factors moderated mothers' distress along different pathways. Parenting efficacy emerged as the most important predictor across different maternal distress levels. Perceived family hardiness behaved in a unique way, evident only with mothers who reported moderate-severe distress levels. Almost half the respondents reported normal-mild distress levels. Economic hardship did not emerge as a significant predictor. The findings reiterate the usefulness of attending to both situation-specific personal efficacy beliefs and trait-like family hardiness in their potential values to buffer mothers living under economic strain. Research and practice implications were identified. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Why did COVID-19 not further harm the mental health of poor mothers? A mixed-method study on low-income families in Singapore.

OBJECTIVES: This paper examines the impact of COVID-19 pandemic on a disadvantaged group of financially poor mothers' mental health conditions in Singapore during the phase of acute COVID-19 infection. DESIGN: A mixed-method design is used. We conducted five focus group discussions with interviewers (n=39) who administered a third wave of survey questionnaire to 424 mothers from low-income families between June and September 2020. The focus group discussions gleaned observations by the interviewers on the risk and stress levels of the mothers during the period leading up to the height of COVID-19 pandemic. In addition, survey data from two time points-pre-COVID-19 and post-COVID-19 pandemic height, measuring the relationship of mother's job loss, income earner loss, marital status, number of children and, permanency of employment and mother's hope levels with mother's depression and anxiety were used to triangulate the observations from the focus group discussions. RESULTS: Majority of the interviewers did not observe any marked increase in stress levels. Correspondingly the quantitative data did not show any significant increase in depression and anxiety scores between wave 2 and 3 results. Qualitative data showed that numerous mothers were able to report different strategies in coping with the financial distress. The government COVID-19 support grants were cited by many as helpful in cushioning the financial stress. Comparing the quantitative measurements, the relationship between loss of income earner and mother's depression and anxiety was moderated by marital status. In addition, the relationship between mother's job loss and mother's depression, as well as loss of income earner and mother's anxiety, was moderated by mother's hope. CONCLUSION: We speculate the relatively stable level of mental health state of financially poor mothers amidst the COVID-19 pandemic to their internal (psychological traits) resilience which is facilitated by the availability of resources in the social milieu through the COVID-19 support grants.

Targeted Lipidomics of Drosophila melanogaster During Development.

Lipids play critical roles in developmental processes, and alterations in lipid metabolism are linked to a wide range of human diseases, including neurodegeneration, cancer, metabolic diseases, and microbial infections. Drosophila melanogaster, more commonly known as the fruit fly, is a powerful organism for developmental biology and human disease research. We have previously developed a comprehensive biochemical tool, based on liquid chromatography-mass spectrometry (LC-MS), to probe the dynamics of lipid remodeling during D. melanogaster development. This chapter introduces a step-by-step protocol for extracting and analyzing lipids across all developmental stages (embryo, larvae, pupa, and adult) of D. melanogaster. The targeted semi-quantitative approach offers a comprehensive coverage of more than 400 lipid species spanning the lipid classes, glycerophospholipids, sphingolipids, triacylglycerols, and sterols.

Enhanced microextraction of endocrine disrupting chemicals adsorbed on airborne fine particulate matter with gas chromatography-tandem mass spectrometric analysis.

A novel double-microextraction approach, combining dispersive liquid-liquid microextraction (DLLME) and vortex-assisted micro-solid-phase extraction (VA-µ-SPE) was developed. The procedure was applied to extract endocrine disrupting chemicals (EDCs) consisting of three phthalate esters (PEs) and bisphenol A (BPA) associated with PM2.5 (airborne particulate matter with aerodynamic diameter ≤ 2.5 µm). Gas chromatography-tandem mass spectrometry (GC-MS/MS) was used for determination of the analytes. These analytes were first ultrasonically desorbed from PM2.5 in a 10% acetone aqueous solution. DLLME was used to first preconcentrate the analytes; the sample solution, still in the same vial, was then subjected to VA-µ-SPE. The synergistic effects provided by the combination of the microextraction techniques provided advantages such as high enrichment factors and good cleanup performance. Various extraction parameters such as type and volume of extractant solvent (for DLLME), and type of sorbent, extraction time, desorption solvent, volume of desorption solvent and desorption time (for µ-SPE) were evaluated. Multi-walled carbon nanotubes were found to be the most suitable sorbent. This procedure achieved good precision with intra- and inter-day relative standard deviations of between 1.93 and 9.95%. Good linearity ranges (0.3-100 ng/mL and 0.5-100 ng/mL, depending on analytes), and limits of detection (LODs) of between 0.07 and 0.15 ng/mL were obtained. The method was used to determine the levels of PEs and BPA in ambient air, with concentrations ranging between below the limits of quantification and 0.48 ng/m3. DLLME-VA-µ-SPE-GC-MS/MS was demonstrated to be suitable for the determination of these EDCs present in PM2.5.

Sodium dodecyl sulfate-multi-walled carbon nanotubes-coated-membrane solid phase extraction of glucocorticoids in aqueous matrices.

A membrane-based solid phase extraction (SPE)-ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method was developed for the determination of nine glucocorticoids in water. This new hybrid SPE approach involved the deposition of sodium dodecyl sulfate (SDS)-multi-walled carbon nanotubes (MWCNTs) on a piece of polypropylene membrane that served as the extraction device. Hitherto, such a sample preparation procedure has not been applied to the analysis of water contaminants before. The use of the surfactant helped to disperse the MWCNTs effectively so that they were coated uniformly onto the polypropylene membrane. This increased the overall extraction efficiency of the procedure. Characterisation of the SDS-MWCNTs material was performed using transmission electron microscopy and scanning electron microscopy. The membrane device did not require a pre-conditioning step. The most favourable extraction parameters such as type of surfactant, percentage of surfactant, type of desorption solvent, stirring rate, desorption time, extraction time, temperature, salting-out effect, pH and diameter of MWCNTs were obtained. The method showed linearity ranges from 0.2 to 100 ng mL-1 for hydrocortisone, dexamethasone, cortisone acetate and beclomethasone dipropionate, and 0.5-100 ng mL-1 for the rest of the analytes. Limits of detection ranging from 0.019 to 0.098 ng mL-1, and limits of quantification ranging from 0.065 to 0.326 ng mL-1, were obtained for the analytes. The intra-day repeatability was between 1.77 and 3.56% while the inter-day reproducibility was between 2.69 and 9.53%, respectively. The method was used to analyse glucocorticoids as contaminants in the canal water samples.

Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation.

OBJECTIVE: The WHO recommends responsive caregiving and early learning (RCEL) interventions to improve early child development (ECD), and to achieve the Sustainable Development Goals' vision of a world where all children thrive. Implementation of RCEL programmes in low and middle-income countries (LMIC) requires evidence to inform decisions about human resources and curricula content. We aimed to describe human resources and curricula content for implementation of RCEL projects across diverse LMICs, using data from the Grand Challenges Canada Saving Brains ECD portfolio. SETTING: We evaluated 32 RCEL projects across 17 LMICs on four continents. PARTICIPANTS: Overall, 2165 workers delivered ECD interventions to 25 909 families. INTERVENTION: Projects were either stand-alone RCEL or RCEL combined with health and nutrition, and/or safety and security. PRIMARY AND SECONDARY OUTCOMES: We undertook a mixed methods evaluation of RCEL projects within the Saving Brains portfolio. Quantitative data were collected through standardised reporting tools. Qualitative data were collected from ECD experts and stakeholders and analysed using thematic content analysis, informed by literature review. RESULTS: Major themes regarding human resources included: worker characteristics, incentivisation, retention, training and supervision, and regarding curricula content: flexible adaptation of content and delivery, fidelity, and intervention duration and dosage. Lack of an agreed standard ECD package contributed to project heterogeneity. Incorporation of ECD into existing services may facilitate scale-up but overburdened workers plus potential reductions in service quality remain challenging. Supportive training and supervision, inducement, worker retention, dosage and delivery modality emerged as key implementation decisions. CONCLUSIONS: This mixed methods evaluation of a multicountry ECD portfolio identified themes for consideration by policymakers and programme leaders relevant to RCEL implementation in diverse LMICs. Larger studies, which also examine impact, including high-quality process and costing evaluations with comparable data, are required to further inform decisions for implementation of RCEL projects at national and regional scales.

Why some children from poor families do well-an in-depth analysis of positive deviance cases in Singapore.

PURPOSE: Research documents that children from low-income families face higher risks in many areas of their development including academic performance. However, some children from low-income homes excel academically despite their disadvantaged environment. METHOD: Using Positive Deviance methodology (PD), audio-diary and interview data were collected from ten children who scored at least 70 percentile in school examinations in spite of their financial deprivation. RESULTS: This paper uncovers specific dimensions of agency in these children that stemmed from the relational contexts they had with their mothers. Combining the PD methodology and sensitizing lens from Social Relational Theory, this study provided evidence that PD children are connected agents within their family. It suggests that children's awareness of their family circumstances motivated them to work hard and enabled them to devise creative ways to manage their limited financial resources. CONCLUSIONS: The findings challenge dominant discourses on poor children as passive victims and suggest new ways for practitioners to examine the relationship contexts that support children's capacity as agents rather than focusing on individual traits.

Paternal involvement of Singaporean fathers within six months postpartum: A follow-up qualitative study.

OBJECTIVE: This study aims to understand paternal involvement within the six-month postpartum period to identify the challenges and needs of Singaporean fathers. DESIGN: The study used a descriptive qualitative design. SETTING AND PARTICIPANTS: This research is a follow-up study of 50 first-time and experienced fathers who were originally interviewed in the early postpartum period. Fathers were recruited from a local public hospital in Singapore. MEASUREMENTS: Individual semi-structured interviews using an interview guide were conducted at six months postpartum with the fathers. The interview recordings were transcribed and analysed using thematic analysis. RESULTS: Four major themes emerged from the analysis: (1) fathers' understanding of their involvement at six months postpartum, (2) challenges of paternal involvement, (3) impact on marital relationship, and (4) needs of fathers. The respondent fathers were determined to be motivated differently during this timepoint as compared to at one week postpartum, but hindrances from work commitments and the presence of support limited paternal involvement. Strained marital relationship and sexual needs surfaced in this study. One father reported to be at risk for depression. Co-parenting practices buffered against marital dissatisfaction. Moreover, the informational needs of fathers differed at one week and six months postpartum. KEY CONCLUSIONS: This follow-up study revealed that the concerns and needs of fathers continue to emerge in accordance with their infants' growth and needs in different postpartum periods. Necessary assistance in the form of long-term follow-ups and online educational resources may be dynamic in supporting the emerging needs of fathers. IMPLICATIONS FOR PRACTICE: Healthcare professionals should engage in interventions that are dynamic in suiting fathers' needs at different time points and cultural contexts.

Identifying Positive Adaptive Pathways in Low-Income Families in Singapore: Protocol for Sequential, Longitudinal Mixed-Methods Design.

BACKGROUND: This study aims to examine the adaptive process of children and mothers from multistressed low-income families in Singapore. It aims to bridge the knowledge gap left by existing poverty studies, which are predominately risk focused. Through a sequential longitudinal mixed-methods design, we will differentiate children and mothers who demonstrate varied social, developmental, and mental health trajectories of outcomes. Through utilizing the Latent Growth Curve Model (LGCM), we aim to detect the development and changes of the positive Family Agency and adaptive capacities of these families over time. The construct of Family Agency is underpinned by the theoretical guidance from the Social Relational Theory, which examines child agency, parent agency, relational agency, and the interactions among these members. It is hypothesized that positive Family Agency within low-income families may lead to better outcomes. The key research questions include whether the extent of positive Family Agency mediates the relationship among financial stress, resource utilization, home environment, and parental stress. OBJECTIVE: The study elucidates the Family Agency construct through interviews with mother-child dyads. It also aims to understand how financial stress and resources are differentially related to home environment, parent stress, and parent and child outcomes. METHODS: In phase 1, 60 mother-child dyads from families receiving government financial assistance and with children aged between 7 and 12 years will be recruited. In-depth interviews will be conducted separately with mothers and children. On the basis of 120 interviews, a measurement for the construct of Family Agency will be developed and will be pilot tested. In phase 2a, a longitudinal survey will be conducted over 3 time points from 800 mother-child dyads. The 3 waves of survey results will be analyzed by LGCM to identify the trajectories of adaptation pathways of these low-income families. In addition, 10 focus groups with up to 15 participants in each will be conducted to validate the LGCM results. RESULTS: This project is funded by the Social Science Research Thematic Grant (Singapore). The recruitment of 60 mother-child dyads has been achieved. Data collection will commence once the amendment to the protocol has been approved by the Institutional Review Board. Analysis of phase 1 data will be completed by the end of the first quarter of 2019, and the first set of results is expected to be submitted for publication by the second quarter of 2019. Phase 2 implementation will commence in the second quarter of 2019, and the project end date is in May 2021. CONCLUSIONS: Findings from this study can potentially inform social policy and programs as it refines the understanding of low-income families by distinguishing trajectories of adaptive capacities so that policies and interventions can be targeted in enhancing the adaptive pathways of low-income families with children. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/11629.

Contextual design choices and partnerships for scaling early child development programmes.

Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 'Transition to Scale' and 34 'Seed') were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources.