Teaching for Student and Societal Wellbeing in HPE: Nine Pedagogies for Social Justice.

We currently find ourselves living in precarious times, with old and new social inequities on the rise due to the challenges associated with an unprecedented rise of global migration and neoliberalism, amplified in our post COVID-19 world. Research has demonstrated that there is a high correlation between inequality at the societal level and the overall health and wellbeing of individuals within those societies. We believe that school health and physical education (HPE) has a significant role to play in addressing and acting on social inequities that impact on the wellbeing of both students and society as a whole. Based on the findings of an international research project called EDUHEALTH which explored pedagogies for social justice in school health and physical education (HPE) across Sweden, Norway and New Zealand, this paper aims to highlight the addressing of (in)equality and student wellbeing through HPE practice. In particular, the paper presents nine different but complementary pedagogies for social justice that we believe can improve individual, collective, and societal wellbeing. We conclude by proposing that, if adopted across a whole school curriculum, these nine pedagogies for social justice could form the basis of a holistic school-wide community approach aimed at improving both student and societal wellbeing.

Social Justice Pedagogies in School Health and Physical Education-Building Relationships, Teaching for Social Cohesion and Addressing Social Inequities.

A focus on equity and social justice in school health and physical education (HPE) is pertinent in an era where there are growing concerns about the impact of neoliberal globalization and the precariousness of society. The aim of the present study was to identify school HPE teaching practices that promote social justice and more equitable health outcomes. Data were generated through 20 HPE lesson observations and post-lesson interviews with 13 HPE teachers across schools in Sweden, Norway, and New Zealand. The data were analysed following the principles of thematic analysis. In this paper, we present and discuss findings related to three overall themes: (i) relationships; (ii) teaching for social cohesion; (iii) and explicitly teaching about, and acting on, social inequities. Collectively, these themes represent examples of the enactment of social justice pedagogies in HPE practice. To conclude, we point out the difficulty of enacting social justice pedagogies and that social justice pedagogies may not always transform structures nor make a uniform difference to all students. However, on the basis of our findings, we are reaffirmed in our view that HPE teachers can make a difference when it comes to contributing to more socially just and equitable outcomes in HPE and beyond.

Safety and immunogenicity of the chlamydia vaccine candidate CTH522 adjuvanted with CAF01 liposomes or aluminium hydroxide: a first-in-human, randomised, double-blind, placebo-controlled, phase 1 trial.

BACKGROUND: Chlamydia is the most common sexually transmitted bacterial infection worldwide. National screening programmes and antibiotic treatment have failed to decrease incidence, and to date no vaccines against genital chlamydia have been tested in clinical trials. We aimed to assess the safety and immunogenicity, in humans, of a novel chlamydia vaccine based on a recombinant protein subunit (CTH522) in a prime-boost immunisation schedule. METHODS: This phase 1, first-in-human, double-blind, parallel, randomised, placebo-controlled trial was done at Hammersmith Hospital in London, UK, in healthy women aged 19-45 years. Participants were randomly assigned (3:3:1) to three groups: CTH522 adjuvanted with CAF01 liposomes (CTH522:CAF01), CTH522 adjuvanted with aluminium hydroxide (CTH522:AH), or placebo (saline). Participants received three intramuscular injections of 85 µg vaccine (with adjuvant) or placebo to the deltoid region of the arm at 0, 1, and 4 months, followed by two intranasal administrations of 30 µg unadjuvanted vaccine or placebo (one in each nostril) at months 4·5 and 5·0. The primary outcome was safety and the secondary outcome was humoral immunogenicity (anti-CTH522 IgG seroconversion). This study is registered with Clinicaltrials.gov, number NCT02787109. FINDINGS: Between Aug 15, 2016, and Feb 13, 2017, 35 women were randomly assigned (15 to CTH522:CAF01, 15 to CTH522:AH, and five to placebo). 32 (91%) received all five vaccinations and all participants were included in the intention-to-treat analyses. No related serious adverse reactions were reported, and the most frequent adverse events were mild local injection-site reactions, which were reported in all (15 [100%] of 15) participants in the two vaccine groups and in three (60%) of five participants in the placebo group (p=0·0526 for both comparisons). Intranasal vaccination was not associated with a higher frequency of related local reactions (reported in seven [47%] of 15 participants in the active treatment groups vs three [60%] of five in the placebo group; p=1·000). Both CTH522:CAF01 and CTH522:AH induced anti-CTH522 IgG seroconversion in 15 (100%) of 15 participants after five immunisations, whereas no participants in the placebo group seroconverted. CTH522:CAF01 showed accelerated seroconversion, increased IgG titres, an enhanced mucosal antibody profile, and a more consistent cell-mediated immune response profile compared with CTH522:AH. INTERPRETATION: CTH522 adjuvanted with either CAF01 or aluminium hydroxide appears to be safe and well tolerated. Both vaccines were immunogenic, although CTH522:CAF01 had a better immunogenicity profile, holding promise for further clinical development. FUNDING: European Commission and The Innovation Fund Denmark.

Physical function of elderly patients with multimorbidity upon acute hospital admission versus 3 weeks post-discharge.

PURPOSE: To evaluate the change in activities of daily living, grip strength and functional mobility in very old patients >75 years old with multimorbidity upon admission to hospital versus 3 weeks after discharge. A second aim was to explore which baseline variables could predict personal activities of daily living 3 weeks after discharge. METHODS: This prospective cohort study included 115 home-dwelling older adults (mean 86 years, standard deviation 5.9). Participants were measured with the Timed Up and Go, grip strength and Barthel Index in hospital (T1) and 3 weeks after discharge (T2). RESULTS: After 3 weeks, the participants had significantly improved their activities of daily living, mobility and muscle strength, but were still physically reduced compared to reference values for age-matched elderly home dwellers and were at high risk of falls and further loss of independence. In the multivariate regression analysis, baseline cognitive function and mobility were independently associated with Barthel Index at T2 and explained 47% of the variance three weeks after discharge. CONCLUSIONS: Our findings highlight the importance of applying performance-based assessments for elderly in hospital. The result indicates that frail old adults acutely admitted to hospital are in need of rehabilitation 3 weeks after hospitalization. Implications for Rehabilitation Older people with multimorbidity improve their physical function 3 weeks after hospitalization. Nevertheless, they still are physically reduced with respect to reference values for age-matched elderly home dwellers and far below the cutoff score for their risk of falls, continued health decline and loosing their independence. The results imply that older people with multimorbidity are in need of early rehabilitation program during hospitalization and after hospitalization. The use of performance-based measurements enables us to identify older adults at highest risk of decline in health and function and is a key of identifying frail older peoples need for rehabilitation. The Time up and Go test, Grip Strength test and the Barthel Index are considered to complement each other and regarded as useful assessments for frail older people in hospital with acute illness.

The Otago Exercise Program performed as group training versus home training in fall-prone older people: a randomized controlled Trial.

BACKGROUND AND PURPOSE: Exercise programs targeting muscle strength and balance can reduce falls. The study aimed to compare the Otago Exercise Program (OEP), originally designed as supervised home training (HT), with the same programme performed as GT, on functional balance and muscle strength, mobility, fall efficacy and self-reported health. METHODS: A single-blind randomized controlled trial with assessments at baseline (T1), following the 12-week intervention (T2), and 3 months following intervention (T3), was performed. 125 people, mean age 82.5 (SD = 5.7) years, 73% women, referred to a Falls Outpatient Clinic, participated. 74% had fallen, and 37% had a fall-related hospital stay during the previous year. OEP supervised by physiotherapists was performed as GT twice weekly or as HT three times a week, for 12 weeks. Total exercise time was comparable between groups. The primary outcome was the Berg Balance Scale assessed at T2. RESULTS: From T1-T2, Berg Balance Scale improved significantly more in the GT group than in the HT group (mean group difference in change of 3.2 points, 95%CI = 0.7-5.8, p = 0.014). Of the secondary outcomes, the 30-second sit-to-stand test (p = 0.004), and physical health measured by the Short Form-36 (p = 0.004), improved significantly more for the GT group. Change in mobility measured by the Timed Up and Go test, mental health by the Short Form-36, and fall efficacy by the Fall Efficacy Scale International did not differ between groups. The 30-second sit-to-stand test and the Timed Up and Go, but not the Berg Balance Scale, was still better in the GT group at T3. DISCUSSION: In fall-prone home-dwelling older people, the OEP performed as GT is more effective for improving functional balance, muscle strength and physical health, but not fall efficacy and mental health than when performed as HT. The OEP provided as GT should be considered in this population.