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1.
Nature ; 554(7693): 451-457, 2018 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-29469099

RESUMO

Recent opposing trends towards earlier physical maturation and later social maturation present a conundrum of apparent biological-social mismatch. Here we use life history analysis from evolutionary ecology to identify forces that drive these shifts. Together with findings in developmental science, our life history analysis indicates that adolescence is a distinctive period for biological embedding of culture. Ethnographic evidence shows that mass education is a novel feature of the globalizing cultural configurations of adolescence, which are driven by transformations in labour, livelihood and lifestyle. Evaluation of the life history trade-offs and sociocultural ecologies that are experienced by adolescents may offer a practical basis for enhancing their development.


Assuntos
Desenvolvimento do Adolescente , Saúde do Adolescente , Cultura , Puberdade/fisiologia , Puberdade/psicologia , Mudança Social , Adolescente , Saúde do Adolescente/tendências , Estatura , Educação/história , Educação/tendências , Feminino , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Aprendizagem/fisiologia , Estilo de Vida , Masculino , Menarca/fisiologia , Fatores de Tempo
2.
Am J Hum Biol ; 33(1): e23410, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32189404

RESUMO

OBJECTIVES: Telomeres are the protective caps of chromosomes. They shorten with cell replication, age, and possibly environmental stimuli (eg, infection and stress). Short telomere length (TL) predicts subsequent worse health. Although venous whole blood (VWB) is most commonly used for TL measurement, other, more minimally invasive, sampling techniques are becoming increasingly common due to their field-friendliness, allowing for feasible measurement in low-resource contexts. We conducted statistical validation work for measuring TL in dried blood spots (DBS) and incorporated our results into a meta-analysis evaluating minimally invasive sampling techniques to measure TL. METHODS: We isolated DNA extracts from DBS using a modified extraction protocol and tested how they endured different shipping conditions and long-term cryostorage. We then included our in-house DBS TL validation statistics (correlation values with VWB TL and age) in a series of meta-analyses of results from 24 other studies that published similar associations for values between TL measured in DBS, saliva, and buccal cells. RESULTS: Our modified DBS extraction technique produced DNA yields that were roughly twice as large as previously recorded. Partially extracted DBS DNA was stable for 7 days at room temperature, and still provided reliable TL measurements, as determined by external validation statistics. In our meta-analysis, DBS TL had the highest external validity, followed by saliva, and then buccal cells-possibly reflecting similarities/differences in cellular composition vs VWB. CONCLUSIONS: DBS DNA is the best proxy for VWB from the three minimally-invasively specimen types evaluated and can be used to expand TL research to diverse settings and populations.


Assuntos
Teste em Amostras de Sangue Seco/métodos , Manejo de Espécimes/métodos , Telômero/fisiologia , Adulto , Teste em Amostras de Sangue Seco/instrumentação , Humanos , Pessoa de Meia-Idade , Manejo de Espécimes/instrumentação , Adulto Jovem
3.
Proc Natl Acad Sci U S A ; 113(29): 8156-61, 2016 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-27402736

RESUMO

Adverse social conditions in early life have been linked to increased expression of proinflammatory genes and reduced expression of antiviral genes in circulating immune cells-the conserved transcriptional response to adversity (CTRA). However, it remains unclear whether such effects are specific to the Western, educated, industrialized, rich, and democratic (WEIRD) cultural environments in which previous research has been conducted. To assess the roles of early adversity and individual psychological resilience in immune system gene regulation within a non-WEIRD population, we evaluated CTRA gene-expression profiles in 254 former child soldiers and matched noncombatant civilians 5 y after the People's War in Nepal. CTRA gene expression was up-regulated in former child soldiers. These effects were linked to the degree of experienced trauma and associated distress-that is, posttraumatic stress disorder (PTSD) severity-more than to child soldier status per se. Self-perceived psychological resilience was associated with marked buffering of CTRA activation such that PTSD-affected former child soldiers with high levels of personal resilience showed molecular profiles comparable to those of PTSD-free civilians. These results suggest that CTRA responses to early life adversity are not restricted to WEIRD cultural contexts and they underscore the key role of resilience in determining the molecular impact of adverse environments.


Assuntos
Militares , Resiliência Psicológica , Estresse Psicológico/genética , Adulto , Criança , Humanos , Nepal , Transtornos de Estresse Pós-Traumáticos/genética , Transcriptoma , Guerra , Adulto Jovem
4.
J Res Adolesc ; 29(1): 9-31, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30869841

RESUMO

In recent decades, theoretical and methodological advances have operated synergistically to advance understanding of puberty and prompt increasingly comprehensive models that engage with the temporal, psychosocial, and biological dimensions of this maturational milepost. This integrative overview discusses these theoretical and methodological advances and their implications for research and intervention to promote human development in the context of changing maturational schedules and massive ongoing social transformations.


Assuntos
Desenvolvimento do Adolescente/fisiologia , Saúde do Adolescente , Neurociências , Puberdade/fisiologia , Maturidade Sexual/fisiologia , Adolescente , Evolução Biológica , Criança , Feminino , Humanos , Masculino , Puberdade/psicologia
5.
Prev Sci ; 17(8): 937-948, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27438294

RESUMO

Almost all pregnant women (98 %) in 24 Cape Town neighborhoods were randomized by neighborhood to (1) the standard care (SC) condition (n = 12 neighborhoods; n = 594 pregnant women) or (2) the Philani Intervention Program (PIP) in which home visits by Community Health Workers (CHW) were conducted (n = 12 neighborhoods; n = 644 pregnant women). At 36 months post-birth (84.6 % follow-up), PIP mothers were significantly less depressed compared to the SC mothers. Children in PIP were significantly less likely to be stunted (24.3 vs 18.1 %, p = 0.013), to have better vocabularies, and were less likely to be hospitalized than children in the SC condition. These data suggest home visits may need to continue for several years post-birth. Sustainable, scalable perinatal intervention models are needed in LMIC.


Assuntos
Saúde da Criança , Agentes Comunitários de Saúde , Visita Domiciliar , Saúde Materna , Avaliação de Resultados em Cuidados de Saúde , Adulto , Depressão Pós-Parto/epidemiologia , Depressão Pós-Parto/terapia , Feminino , Humanos , Gravidez , África do Sul/epidemiologia , Adulto Jovem
6.
Am J Hum Biol ; 27(1): 27-40, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25380194

RESUMO

The anthropological study of human biology, health, and child development provides a model with potential to address the gap in population-wide mental health interventions. Four key concepts from human biology can inform public mental health interventions: life history theory and tradeoffs, redundancy and plurality of pathways, cascades and multiplier effects in biological systems, and proximate feedback systems. A public mental health intervention for former child soldiers in Nepal is used to illustrate the role of these concepts in intervention design and evaluation. Future directions and recommendations for applying human biology theory in pursuit of public mental health interventions are discussed.


Assuntos
Saúde Mental , Militares , Prevenção Primária , Prevenção Secundária , Estresse Psicológico/prevenção & controle , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Humanos , Nepal , Estresse Psicológico/terapia
7.
Int Rev Psychiatry ; 27(3): 180-96, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26100613

RESUMO

Despite increased attention to global mental health, psychiatric genetic research has been dominated by studies in high-income countries, especially with populations of European descent. The objective of this study was to assess single nucleotide polymorphisms (SNPs) in the FKBP5 gene in a population living in South Asia. Among adults in Nepal, depression was assessed with the Beck Depression Inventory (BDI), post-traumatic stress disorder (PTSD) with the PTSD Checklist-Civilian Version (PCL-C), and childhood maltreatment with the Childhood Trauma Questionnaire (CTQ). FKBP5 SNPs were genotyped for 682 participants. Cortisol awakening response (CAR) was assessed in a subsample of 118 participants over 3 days. The FKBP5 tag-SNP rs9296158 showed a main effect on depressive symptoms (p = 0.03). Interaction of rs9296158 and childhood maltreatment predicted adult depressive symptoms (p = 0.02) but not PTSD. Childhood maltreatment associated with endocrine response in individuals homozygous for the A allele, demonstrated by a negative CAR and overall hypocortisolaemia in the rs9296158 AA genotype and childhood maltreatment group (p < 0.001). This study replicated findings related to FKBP5 and depression but not PTSD. Gene-environment studies should take differences in prevalence and cultural significance of phenotypes and exposures into account when interpreting cross-cultural findings.


Assuntos
Maus-Tratos Infantis , Depressão , Interação Gene-Ambiente , Hidrocortisona/metabolismo , Classe Social , Transtornos de Estresse Pós-Traumáticos , Proteínas de Ligação a Tacrolimo/genética , Adulto , Criança , Maus-Tratos Infantis/etnologia , Maus-Tratos Infantis/estatística & dados numéricos , Depressão/etnologia , Depressão/etiologia , Depressão/genética , Depressão/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/etnologia , Transtornos de Estresse Pós-Traumáticos/etnologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/genética , Transtornos de Estresse Pós-Traumáticos/metabolismo
8.
J Pediatr ; 163(5): 1443-7, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23919906

RESUMO

OBJECTIVE: To test whether children and adolescents with co-occurring asthma and depression are at risk for elevated inflammation-concurrently and at the next assessment. STUDY DESIGN: Up to 6 yearly assessments per person from the prospective, population-based Great Smoky Mountains Study (N = 1420) were used, covering children in the community aged 10-16 years old. High-sensitivity C-reactive protein (CRP) was assayed from annual bloodspot collections and provided indicators of elevated inflammation at CRP > 1, CRP > 2, and CRP > 3 mg/L. Depression was assessed with the Child and Adolescent Psychiatric Assessment. Asthma was assessed using a form adapted from the Centers for Disease Control and Prevention National Health Interview Survey. RESULTS: Controlling common covariates of CRP, the co-occurrence of asthma and depression predicted heightened CRP-concurrently and at the next assessment. In turn, elevated CRP was relatively stable from one assessment to the next. CONCLUSIONS: The co-occurrence of asthma and depression in childhood poses a risk for substantially elevated inflammation concurrently and over time, which could contribute to pathophysiological processes involved in the development of additional chronic diseases and also to asthma--related morbidity and mortality.


Assuntos
Asma/complicações , Depressão/complicações , Inflamação/complicações , Adolescente , Asma/psicologia , Índice de Massa Corporal , Proteína C-Reativa/análise , Criança , Comorbidade , Emoções , Feminino , Humanos , Inflamação/diagnóstico , Estudos Longitudinais , Masculino , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Inquéritos e Questionários
9.
J Trauma Stress ; 26(2): 233-40, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23526635

RESUMO

This study examined bereaved children's HPA-axis functioning (cortisol awakening response; CAR) in relation to psychological distress, coping, and surviving parents' grief reactions. Participants included 38 children (20 girls) with recent parental loss (previous 6 months) and 28 of their surviving caregivers (23 women) who were assessed using self-report instruments and in-person, semistructured interviews. Interviews involved discussions about the child's thoughts and feelings related to the loss. Participants provided 3 saliva samples at home (awakening, 30 minutes later, and evening) over 3 successive days, beginning on the day following the interview. Results show a significant relation between dampening of the child's Day 1 CAR and more symptoms of anxiety (r = -.45), depression (r = -.40), posttraumatic stress (r = -.45), and maladaptive grief (r = -.43), as well as higher levels of avoidant coping (r = -.53). Higher levels of parental maladaptive grief were also associated (r = -.47) with a dampening of the child's Day 1 CAR. Our results raise the possibility that blunted CAR may be a result of accumulating allostatic load and/or a result of emotionally challenging events (discussions regarding the deceased) and their subsequent processing (or lack thereof) within the family, which may be particularly stressful for those bereaved children experiencing high levels of psychological distress, avoidant coping, and parental maladaptive grief.


Assuntos
Adaptação Psicológica/fisiologia , Pesar , Hidrocortisona/análise , Morte Parental/psicologia , Pais/psicologia , Adulto , Criança , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/fisiologia , Relações Pais-Filho , Sistema Hipófise-Suprarrenal/fisiologia , Saliva/química , Estresse Psicológico , Inquéritos e Questionários
10.
Soc Sci Med ; 324: 115853, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37001280

RESUMO

BACKGROUND: South African mothers confront synergistic challenges from depression, alcohol use, and HIV/AIDS. The importance of maternal functioning for child development motivates interventions, yet long-term outcomes seldom are tracked. Furthermore, little is known about trajectories and the role of social-cultural factors in maternal depression and alcohol use across parenthood in low- and middle-income countries. METHODS: We examined maternal outcomes at 5- and 8-years' post-birth, from the Philani Intervention Program (PIP), a randomized controlled trial of a prenatally-initiated home visiting intervention lasting through 6 months' post-birth which yielded some benefits for children and mothers through 3 years. Longitudinal Bayesian mixed-effects models assessed intervention effects for maternal depression and alcohol use from pre-birth through 8 years post-birth. We plotted trajectories of depression and alcohol use and analyzed their relationship over time. RESULTS: Maternal benefits appeared limited and intervention outcomes differed at 5 and 8 years. Reduced depression in PIP versus standard care (SC) mothers at 3 years disappeared by 5 and 8 years. Depression prevalence declined from 35.1% prenatally to 5.5% at 8 years, independent of intervention or alcohol use. Alcohol use in both groups rebounded from a post-birth nadir; fewer PIP than SC mothers drank alcohol and reported problematic use at 5 but not 8 years. HIV+ prevalence did not differ by condition and increased from 26% to 45% over the reported period. CONCLUSIONS: Dissipation of early child benefits from home visiting by age 8 years likely reflects lack of durable change in maternal behaviors compounded by social-cultural factors and cumulative effects of community deprivation. High prenatal rates warrant screening and treatment for depression in standard antenatal care. Low-and-middle income countries may need sustained interventions, including alcohol use reduction, to capitalize on initial gains from targeted interventions and address community social-cultural factors. HIV/AIDS continues to spread in this population.


Assuntos
Síndrome da Imunodeficiência Adquirida , Depressão , Criança , Feminino , Gravidez , Humanos , África do Sul/epidemiologia , Depressão/epidemiologia , Teorema de Bayes , Seguimentos , Mães , Visita Domiciliar
11.
Lancet Psychiatry ; 10(6): 452-464, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37182526

RESUMO

Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.


Assuntos
Transtornos Mentais , Suicídio , Humanos , Mortalidade Prematura , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Saúde Mental , Atenção à Saúde
12.
Br J Psychiatry ; 201(4): 268-75, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22878131

RESUMO

BACKGROUND: Post-conflict mental health studies in low-income countries have lacked pre-conflict data to evaluate changes in psychiatric morbidity resulting from political violence. AIMS: This prospective study compares mental health before and after exposure to direct political violence during the People's War in Nepal. METHOD: An adult cohort completed the Beck Depression Inventory and Beck Anxiety Inventory in 2000 prior to conflict violence in their community and in 2007 after the war. RESULTS: Of the original 316 participants, 298 (94%) participated in the post-conflict assessment. Depression increased from 30.9 to 40.6%. Anxiety increased from 26.2 to 47.7%. Post-conflict post-traumatic stress disorder (PTSD) was 14.1%. Controlling for ageing, the depression increase was not significant. The anxiety increase showed a dose-response association with conflict exposure when controlling for ageing and daily stressors. No demographic group displayed unique vulnerability or resilience to the effects of conflict exposure. CONCLUSIONS: Conflict exposure should be considered in the context of other types of psychiatric risk factors. Conflict exposure predicted increases in anxiety whereas socioeconomic factors and non-conflict stressful life events were the major predictors of depression. Research and interventions in post-conflict settings therefore should consider differential trajectories for depression v. anxiety and the importance of addressing chronic social problems ranging from poverty to gender and ethnic/caste discrimination.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Política , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Violência/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Pobreza/psicologia , Estudos Prospectivos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Fatores de Risco
13.
Cereb Cortex ; 21(3): 636-46, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20713504

RESUMO

Sex differences in age- and puberty-related maturation of human brain structure have been observed in typically developing age-matched boys and girls. Because girls mature 1-2 years earlier than boys, the present study aimed at assessing sex differences in brain structure by studying 80 adolescent boys and girls matched on sexual maturity, rather than age. We evaluated pubertal influences on medial temporal lobe (MTL), thalamic, caudate, and cortical gray matter volumes utilizing structural magnetic resonance imaging and 2 measures of pubertal status: physical sexual maturity and circulating testosterone. As predicted, significant interactions between sex and the effect of puberty were observed in regions with high sex steroid hormone receptor densities; sex differences in the right hippocampus, bilateral amygdala, and cortical gray matter were greater in more sexually mature adolescents. Within sex, we found larger volumes in MTL structures in more sexually mature boys, whereas smaller volumes were observed in more sexually mature girls. Our results demonstrate puberty-related maturation of the hippocampus, amygdala, and cortical gray matter that is not confounded by age, and is different for girls and boys, which may contribute to differences in social and cognitive development during adolescence, and lasting sexual dimorphisms in the adult brain.


Assuntos
Córtex Cerebral/crescimento & desenvolvimento , Puberdade/fisiologia , Caracteres Sexuais , Adolescente , Criança , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino
14.
JMIR Form Res ; 6(1): e30360, 2022 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-35084340

RESUMO

BACKGROUND: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people's behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. OBJECTIVE: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. METHODS: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants' perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. RESULTS: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). CONCLUSIONS: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM.

15.
Transcult Psychiatry ; 59(3): 362-379, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35072562

RESUMO

The purpose of this study was to characterize trauma exposure and mental health burden among men who have sex with men (MSM) in Hanoi, Vietnam. Participants comprise 100 HIV-positive and 98 high-risk, HIV-negative MSM, ranging from 18 to 29 years of age. Data were collected using the Childhood Trauma Questionnaire, Traumatic Events Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and PTSD Symptom Scale. A subset of participants (n = 12) were also interviewed to evaluate community perception of the prevalence, causation, and available treatment options for mental health issues within the MSM community in Vietnam. In our sample, 23.2% reported having experienced moderate-to-severe childhood physical abuse; 18.7% physical neglect; 13.6% emotional abuse; 11.1% emotional neglect; and 26.8% sexual abuse. Such trauma exposure continued into adulthood and manifested most commonly in the form of interpersonal violence. Approximately 37.4% of the sample met the criteria for probable PTSD; 26.8% for moderate-to-severe depression; and 20.2% for moderate-to-severe anxiety. Neither exposure nor mental health burden differed by serostatus. Linear regression revealed that childhood emotional abuse was the only sub-type of trauma significantly associated with depression, anxiety, and PTSD symptoms. The majority of interviewees believed that mental health burden was higher among MSM relative to the general population and attributed this to their vulnerability to interpersonal violence and lack of available coping resources. However, few believed that these mental health issues warranted clinical attention, and only one participant was able to identify a mental health service provider. Our findings suggest that trauma exposure and mental health burden are prevalent among MSM, irrespective of serostatus, and much higher than what has been previously reported among the general population in Vietnam.


Assuntos
Minorias Sexuais e de Gênero , Transtornos de Estresse Pós-Traumáticos , Adulto , Transtornos de Ansiedade , Homossexualidade Masculina/psicologia , Humanos , Masculino , Saúde Mental , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Vietnã/epidemiologia
16.
Prev Sci ; 12(4): 372-88, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21850488

RESUMO

Pregnant mothers in South African townships face multiple health risks for themselves and their babies. Existing clinic-based services face barriers to access, utilization, and human resource capacities. Home visiting by community health workers (CHW) can mitigate such barriers. The Philani Plus (+) Intervention Program builds upon the original Philani CHW home-visiting intervention program for maternal and child nutrition by integrating content and activities to address HIV, alcohol, and mental health. Pregnant Mothers at Risk (MAR) for HIV, alcohol, and/or nutrition problems in 24 neighborhoods in townships in Cape Town, South Africa (n = 1,239) were randomly assigned by neighborhood to an intervention (Philani Plus (+), N = 12 neighborhoods; n = 645 MAR) or a standard-care control condition of neighborhood clinic-based services (N = 12 neighborhoods; n = 594 MAR). Positive peer deviant "Mentor Mother" CHWs are recruited from the township neighborhoods and trained to deliver four antenatal and four postnatal home visits that address HIV, alcohol, nutrition, depression, health care regimens for the family, caretaking and bonding, and securing government-provided child grants. The MAR and their babies are being monitored during pregnancy, 1 week post-birth, and 6 and 18 months later. Among the 1,239 MAR recruited: 26% were HIV-positive; 27% used alcohol during pregnancy; 17% previously had low-birthweight babies; 23% had at least one chronic condition (10% hypertension, 5% asthma, 2% diabetes); 93% had recent sexual partners with 10% known to be HIV+; and 17% had clinically significant prenatal depression and 42% had borderline depression. This paper presents the intervention protocol and baseline sample characteristics for the "Philani Plus (+)" CHW home-visiting intervention trial.


Assuntos
Serviços de Saúde da Criança/organização & administração , Enfermagem em Saúde Comunitária , Visita Domiciliar , Serviços de Saúde Materna/organização & administração , Mentores , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Gravidez , Desenvolvimento de Programas , África do Sul
17.
Soc Sci Med ; 279: 113978, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34000583

RESUMO

INTRODUCTION: Globally, men who have sex with men (MSM) experience a disproportionate burden of mental health issues. While HIV service providers may possess the skills and relationships to provision mental health and psychosocial support (MHPSS) to this population, task-sharing models that integrate MHPSS into HIV contexts remain limited. The aim of this study was to explore the sociodemographic, psychological, and structural factors operant at the client and HIV service provider levels that shape MHPSS access and burden among MSM and opportunities for integration in Vietnam. METHODS: Between June and August 2018, semi-structured interviews were conducted with 20 MSM and 13 service providers at out-patient clinics (OPCs) and community-based organizations (CBOs) in Hanoi, Vietnam. Interviews explored participants' understandings of and experiences with the signs, causes, and appropriate treatments for mental health concerns; and perceived barriers to MHPSS integration in HIV contexts. Data were coded thematically and analyzed in MAXQDA. RESULTS: Most MSM did not view their mental distress as constituting illness or as warranting clinical attention. Specifically, terms like "mental illness" were often associated with being "crazy" or immoral, while symptoms of distress were interpreted as having to do with everyday difficulties associated with being MSM and/or HIV-positive. Due to mental health stigma, MSM were reluctant to access services while service providers were similarly reluctant to query about needs. Few service providers knew where to refer patients for MHPSS, and none had done so previously. Most service providers reported lacking the human capital, expertise, and funding to address MHPSS needs. CONCLUSIONS: Our findings suggest that aside from mental health stigma, future integration strategies must address competing demands and incentivization structures, limitations in existing mental health infrastructure and funding, misperceptions around MHPSS needs and symptoms, and opportunities to streamline MHPSS with existing CBO activities to strengthen community wellbeing.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Saúde Mental , Pesquisa Qualitativa , Vietnã
18.
Am J Hum Biol ; 22(5): 657-66, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20737613

RESUMO

OBJECTIVES: This study examines sex differences in vulnerability among children experiencing rapid culture change that may reflect distinct microecologies driven by differential parental investment and/or sex-specific life history strategies. Apparent female growth canalization may be a life history strategy favoring growth over maintenance but also may reflect sex-differentiated selection for resilience based on unequal treatment during early life. METHODS: Stature, weight, and serum measures of C-reactive protein (CRP, an inflammation marker) and Epstein-Barr Virus antibodies (EBV, a humoral immune response marker) were collected longitudinally among children/adolescents ages 5-20 years (N = 65), 5-9 years after sustained contact in a fringe highland hunter-horticulturalist group from the Schrader Range in Papua New Guinea exhibiting male preference and sex-biased survival. It was hypothesized that girls would exhibit canalization, with better nutritional status than boys; lower maintenance investment would yield lower female immune activation; and because of differential survivorship, females would appear increasingly canalized as early conditions for girls worsened relative to boys. RESULTS: Girls had greater arm circumference z-scores than boys, less frequent stunting, and lower CRP despite high pathogen load. Average nutritional status for girls improved over time as the sex ratio became increasingly male biased and the condition of female infants reportedly worsened. CONCLUSIONS: Both canalization and survivorship effects were found. Although a life history perspective on female canalization can help explain developmental outcomes in populations undergoing rapid culture change amid adversity, possible sex differences in the strength of survivorship effects that select for resiliency should not be ignored.


Assuntos
Aculturação , Fenômenos Fisiológicos da Nutrição Infantil , Sistema Imunitário , Estado Nutricional , Preconceito , Adolescente , Adulto , Anticorpos Antivirais/sangue , Estatura , Peso Corporal , Proteína C-Reativa/química , Criança , Pré-Escolar , Países em Desenvolvimento , Feminino , Herpesvirus Humano 4/imunologia , Humanos , Estudos Longitudinais , Masculino , Papua Nova Guiné , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
19.
Child Dev Perspect ; 14(1): 9-14, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33880131

RESUMO

Based on the recommendations of a Task Force on Scientific Integrity and Openness it appointed, the Governing Council of the Society for Research in Child Development (SRCD) adopted a Policy on Scientific Integrity and Openness (SRCD, 2019a) and accompanying Author Guidelines on Scientific Integrity and Openness for Publishing in Child Development (SRCD, 2019b). Here we discuss some of the challenges associated with realizing SRCD's vision for a science of child development that is open, transparent, robust, impactful, and conducted with the highest standards of integrity. In identifying the challenges-protecting participants and researchers from harm, respecting diversity, and balancing the benefits of change with the costs -we also offer constructive solutions.

20.
Glob Pediatr Health ; 7: 2333794X20917570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32523976

RESUMO

Current approaches to longitudinal assessment of children's developmental and psychological well-being, as mandated in the United Nations Sustainable Development Goals, are expensive and time consuming. Substantive understanding of global progress toward these goals will require a suite of new robust, cost-effective research tools designed to assess key developmental processes in diverse settings. While first steps have been taken toward this end through efforts such as the National Institutes of Health's Toolbox, experience-near approaches including naturalistic observation have remained too costly and time consuming to scale to the population level. This perspective presents 4 emerging technologies with high potential for advancing the field of child health and development research, namely (1) affective computing, (2) ubiquitous computing, (3) eye tracking, and (4) machine learning. By drawing attention of scientists, policy makers, investors/funders, and the media to the applications and potential risks of these emerging opportunities, we hope to inspire a fresh wave of innovation and new solutions to the global challenges faced by children and their families.

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