Adapting Attachment and Biobehavioral Catch-up for infants and young children with intellectual disabilities and developmental delays in South Africa: Reflections and recommendations from local stakeholders.

Attachment and Biobehavioral Catch-up (ABC) is an intervention targeted at enhancing the socioemotional and regulatory functioning of at-risk infants. However, to use the ABC for infants/toddlers with intellectual disabilities/developmental delays (ID/DD) and in novel cultural contexts, such as South Africa, adaptations may be required. This study aimed, therefore, to explore the opinions of clinical experts and perceptions of caregivers regarding the use of ABC for children with ID/DD in South Africa. It also sought to incorporate the experiences of families of children with ID/DD who received, and intervenors who delivered, ABC in its first implementation in South Africa. Semi-structured interviews were conducted with 18 participants. Thematic analysis explicated 12 main themes: Intervention Strengths, Points of Concern, and Recommendations (Experts); Focus on Caregiver-child Relationship, and Intervention Targets and Duration (Caregivers); Benefits of ABC, and Cultural Considerations (ABC Recipients); Focused and Targeted, Value of Feedback, Supportive Supervision, Working Alliance, and Challenges Experienced (ABC Intervenors). Practice and training recommendations include psychoeducation for parents and training for intervenors that is ID/DD-specific, expanding supervision capacity, building intervenors' cultural/linguistic sensitivity and competence, accessing referral networks, including local Community Health Workers as intervenors, and greater flexibility in how the sessions are organized.

La intervención de Afectividad y Alcance del Bio-comportamiento (ABC) está dirigida a mejorar el funcionamiento socioemocional y regulatorio de los infantes bajo riesgo. Sin embargo, para usar el ABC para infantes y niños pequeñitos con discapacidades intelectuales / retrasos en el desarrollo (ID/DD) y dentro de nuevos contextos culturales, tal como en Sudáfrica, se requieren adaptaciones. Este estudio se propuso, por tanto, explorar las opiniones de expertos clínicos y las percepciones de quienes prestan el cuidado acerca del uso del ABC con niños con ID/DD en Sudáfrica. También buscaba incorporar las experiencias de familias de niños con ID/DD que recibían, así como de practicantes de la intervención que ofrecían el servicio de ABC durante su primera implementación en Sudáfrica. Se llevaron a cabo entrevistas semiestructuradas con 18 participantes. Análisis temáticos explicaron los 12 principales temas: Puntos Fuertes de la Intervención, Puntos que Preocupan y Recomendaciones (Expertos); Enfoque en la Relación Cuidador-Niño y Metas de Enfoque y Duración de la Intervención (Cuidadores); Beneficios del ABC y Consideraciones Culturales (Quienes recibían el ABC); Lo Enfocado y Diseñado como Meta, Valor de Ideas Recibidas, Supervisión con Apoyo, Alianza de Trabajo y Retos Experimentados (Practicantes de la Intervención ABC). Las recomendaciones de práctica y entrenamiento incluyen la psico-educación de padres, entrenamiento a quienes practican la intervención específicamente orientada a ID/DD, expandir la capacidad de supervisión, formar la sensibilidad y competencia cultural/lingüística de quienes practican la intervención, acceso a los sistemas de referencias, incluir Trabajadores de Salud Comunitarios como practicantes de la intervención y mayor flexibilidad en cómo organizar las sesiones.

L'attachement et le rattrapage bio-comportemental (en anglais Attachment and Biobehavioral Catch-up, soit ABC) est une intervention ciblée sur l'amélioration du fonctionnement socio-émotionnel et régulatoire de bébés à risques. Cependant, pour utiliser l'ABC pour des bébés/jeunes enfants avec des retards intellectuels et des retards du comportement (ID/DD) et dans des contextes culturels nouveaux, comme l'Afrique du Sud, des adaptations pourraient être nécessaires. Par conséquent cette étude s'est donné pour but d'explorer les opinions d'experts cliniques et les perceptions des personnes prenant soin d'un bébé quant à l'utilisation de l'ABC pour des enfants avec ID/DD en Afrique du Sud. On a aussi cherché à incorporer les expériences de familles d'enfants avec ID/DD qui ont reçu l'ABC, ainsi que des intervenants qui l'ont facilité, dans sa première mise en oeuvre en Afrique du Sud. Des entretiens semi-structurés ont été faits avec 18 participants. Une analyse thématique a explicité 12 thèmes principaux: Forces de l'Intervention, Points d'Inquiétude, et Recommandations (Experts); Accent sur la Relation Personne prenant soin de l'enfant-enfant et Cibles d'Intervention et Durée d'Intervention (Personnes prenant soin d'un bébé); Bénéfices de l'ABS, et Considérations Culturels (personnes ayant reçu l'ABC); Ciblé et Centré, Valeur du Retour, Supervision de Soutien, Alliance entre entités, et Défis Vécus (Intervenants ABC). Les recommandations de pratique et de formation incluent une psychoéducation pour les parents, une formation pour les intervenants qui est spécifique à l'ID/DD, l'élargissement de la capacité de supervision, le développement de la sensibilité et de la compétence culturelle/linguistique des intervenants, l'accès aux réseau d'orientation, y compris des Travailleurs de Santé Communautaires en tant qu'intervenants, et une plus grande flexibilité dans la manière dont les sessions sont organisées.

Using Attachment and Biobehavioral Catch-up with young children with developmental delays: A multiple-baseline trial of attachment, sensitivity, and cortisol.

The Attachment and Biobehavioral Catchup intervention potentially offsets psychosocial risks facing dyads in which children have intellectual disability or developmental delays. In this single-case multiple-baseline study the efficacy of this intervention was tested across three such South African families. Maternal sensitivity, attachment security, and child affect regulation were measured weekly during a baseline and intervention period, using the Ainsworth Maternal Sensitivity Scales, Attachment Q-sort and salivary cortisol, respectively. Furthermore, post-intervention interviews invited parents' and intervenors' evaluations of the intervention. Visual analysis broadly indicated improvement in maternal sensitivity and attachment security across subjects over time following the introduction of the intervention, although randomisation tests were not statistically significant. Effects on affect regulation were not clearly observed and may have been influenced by case-specific variables. Parent-participants and intervenors also identified particularly helpful contributions from the intervention. Findings underscore the importance of individual-level effects evaluation, especially when implementing interventions outside the original population.

Psychological effects of multimedia-induced sexualisation of girls in middle childhood: a systematic literature review.

OBJECTIVE: The aim of this study was to systematically review available literature pertaining to the psychological effects of multimedia-induced sexualisation of girls in middle childhood (between the ages of 6 and 12 years old). METHOD: A systematic review was conducted through a comprehensive electronic search. Nineteen studies were included in the review and the data was analysed by means of qualitative content analysis. RESULTS: Two themes were identified, namely: 1) detrimental psychological effects of sexualisation; and 2) beneficial psychological effects of sexualisation. Findings appeared to indicate that the psychological effects on girls in middle childhood resulting from sexualisation, such as internalisation, mental health problems, objectification and gender stereotyping, were more likely to be detrimental than beneficial to their well-being. The review also found a paucity of research on the topic within developing countries. Consequently, the authors recommended a precautionary approach pertaining to sexualisation of girls in middle childhood. CONCLUSION: A thorough understanding of the topic is valuable as it can inform a preventative and proactive management approach. It can especially assist in informing policy as well as therapists by informing their developmental conceptualisation and treatment of girls in middle childhood.

South African mothers' coping with an unplanned Caesarean section.

In this study, researchers explored mothers' coping strategies in dealing with birth by unplanned Caesarean section. Mothers' experiences of a traumatic birth could be influenced by perceived strengths when coping with the stress related to the incident. Coping strategies resulted in reassessment of the birth process and were associated with a more positive and memorable experience. In-depth interviews with 10 women explored their lived experiences of childbirth. Data were analyzed thematically. Phenomenological theory served as a framework for the structuring, organizing, and categorizing of data. Mothers described several factors and coping strategies that they perceived to be effective in reducing the impact of their traumatic birth experiences.

Longitudinal changes in CD4(+) T-cell memory responses induced by BCG vaccination of newborns.

BACKGROUND: Improved vaccination strategies against tuberculosis are needed, such as approaches to boost immunity induced by the current vaccine, BCG. Design of these strategies has been hampered by a lack of knowledge of the kinetics of the human host response induced by neonatal BCG vaccination. Furthermore, the functional and phenotypic attributes of BCG-induced long-lived memory T-cell responses remain unclear. METHODS: We assessed the longitudinal CD4 T-cell response following BCG vaccination of human newborns. The kinetics, function, and phenotype of these cells were measured using flow cytometric whole-blood assays. RESULTS: We showed that the BCG-specific CD4 T-cell response peaked 6-10 weeks after vaccination and gradually waned over the first year of life. Highly activated T-helper 1 cells, predominantly expressing interferon γ, tumor necrosis factor α, and/or interleukin 2, were present at the peak response. Following contraction, BCG-specific CD4 T cells expressed high levels of Bcl-2 and displayed a predominant CD45RACCR7 central memory phenotype. However, cytokine and cytotoxic marker expression by these cells was more characteristic of effector memory cells. CONCLUSIONS: Our findings suggest that boosting of BCG-primed CD4 T cells with heterologous tuberculosis vaccines may be best after 14 weeks of age, once an established memory response has developed.

Functional capacity of Mycobacterium tuberculosis-specific T cell responses in humans is associated with mycobacterial load.

High Ag load in chronic viral infections has been associated with impairment of Ag-specific T cell responses; however, the relationship between Ag load in chronic Mycobacterium tuberculosis infection and functional capacity of M. tuberculosis-specific T cells in humans is not clear. We compared M. tuberculosis-specific T cell-associated cytokine production and proliferative capacity in peripheral blood from adults with progressively higher mycobacterial loads-that is, persons with latent M. tuberculosis infection (LTBI), with smear-negative pulmonary tuberculosis (TB), and smear-positive TB. Patients with smear-positive TB had decreased polyfunctional IFN-γ(+)IL-2(+)TNF-α(+) and IL-2-producing specific CD4 T cells and increased TNF-α single-positive cells, when compared with smear-negative TB and LTBI. TB patients also had increased frequencies of M. tuberculosis-specific CD8 T cells, compared with LTBI. M. tuberculosis-specific CD4 and CD8 T cell proliferative capacity was profoundly impaired in individuals with smear-positive TB, and correlated positively with ex vivo IFN-γ(+)IL-2(+)TNF-α(+) CD4 T cells, and inversely with TNF-α single-positive CD4 T cells. During 6 mo of anti-TB treatment, specific IFN-γ(+)IL-2(+)TNF-α(+) CD4 and CD8 T cells increased, whereas TNF-α and IFN-γ single-positive T cells decreased. These results suggest progressive impairment of M. tuberculosis-specific T cell responses with increasing mycobacterial load and recovery of responses during therapy. Furthermore, these data provide a link between specific cytokine-producing subsets and functional capacity of M. tuberculosis-specific T cells, and between the presence of specific CD8 T cells ex vivo and active TB disease. These data have potentially significant applications for the diagnosis of TB and for the identification of T cell correlates of TB disease progression.

A phase IIa trial of the new tuberculosis vaccine, MVA85A, in HIV- and/or Mycobacterium tuberculosis-infected adults.

RATIONALE: Novel tuberculosis (TB) vaccines should be safe and effective in populations infected with Mycobacterium tuberculosis (M.tb) and/or HIV for effective TB control. OBJECTIVE: To determine the safety and immunogenicity of MVA85A, a novel TB vaccine, among M.tb- and/or HIV-infected persons in a setting where TB and HIV are endemic. METHODS: An open-label, phase IIa trial was conducted in 48 adults with M.tb and/or HIV infection. Safety and immunogenicity were analyzed up to 52 weeks after intradermal vaccination with 5 × 10(7) plaque-forming units of MVA85A. Specific T-cell responses were characterized by IFN-γ enzyme-linked immunospot and whole blood intracellular cytokine staining assays. MEASUREMENTS AND MAIN RESULTS: MVA85A was well tolerated and no vaccine-related serious adverse events were recorded. MVA85A induced robust and durable response of mostly polyfunctional CD4(+) T cells, coexpressing IFN-γ, tumor necrosis factor-α, and IL-2. Magnitudes of pre- and postvaccination T-cell responses were lower in HIV-infected, compared with HIV-uninfected, vaccinees. No significant effect of antiretroviral therapy on immunogenicity of MVA85A was observed. CONCLUSIONS: MVA85A was safe and immunogenic in persons with HIV and/or M.tb infection. These results support further evaluation of safety and efficacy of this vaccine for prevention of TB in these target populations.

Continuous glucose monitoring empowers adolescents to take responsibility of diabetes management.

BACKGROUND: Managing diabetes is especially challenging for adolescents, and they often struggle to believe they can manage the condition. Illness perception has been widely associated with better diabetes management outcomes, but the influence of continuous glucose monitoring (CGM) on adolescents has been largely neglected. AIM: The study aimed to explore the illness perception of a group of adolescents living with type 1 diabetes (T1D) using CGM. SETTING: The study was conducted at a medical centre that provides diabetes care services to youth living with T1D in Parktown, South Africa. METHODS: A qualitative research approach using semi-structured online interviews was used to gather data that was thematically analysed. RESULTS: Themes emerging from the data confirmed that CGM creates a sense of control over diabetes management as blood glucose measures were more visible. A sense of normalcy was established as CGM influences a new routine and a way of life, integrating diabetes into a young person's identity. Despite the users' awareness of being different due to diabetes management, CGM assisted in creating a sense of belonging, contributing to developing a better quality of life. CONCLUSION: Findings of this study support the use of CGM as a means of empowering adolescents struggling with diabetes management to achieve better treatment outcomes. The important role of illness perception in facilitating this change was also evident.Contribution: By listening to the adolescent's voice, CGM was identified as a possible intervention to empower adolescents to improve diabetes management.

Identification of psychological constructs for a positive psychology intervention to assist with the adjustment to closed loop technology among adolescents living with type 1 diabetes.

Aim: Adolescents have been identified as the group who struggle most with successful adjustment to closed loop technology. This study aims to identify the psychological constructs that should form part of a positive psychology intervention to assist with the adjustment to closed loop technology among adolescents living with type 1 diabetes. Method: Qualitative document analysis was employed to integrate findings from two documents: a published ongoing intervention study and a recent phenomenological study by the authors. Reflexive thematic analysis was used to identify themes from the documents. Findings: The following themes were identified as important psychological constructs that aid adjustment: the importance of knowledge and education; the process of positive adjustment to closed loop technology; a positive outlook; and building a relationship with diabetes. Conclusion: Interventions are needed to assist adolescents in their adjustment to closed loop technology. The psychological constructs identified served as a starting point in designing an effective, evidence-based intervention grounded in data and theory. Knowledge and education, responsibility, identity, positive affect, gratitude, support, and trust are psychological constructs that need to be included in an intervention program.

Young adult women's meaning-making of living with type 1 diabetes: towards growth and optimism.

Objective: Type 1 diabetes is primarily researched as a medical condition; an examination of the subjective experience of it appears to be neglected. This study explored young women's meaning-making of living with type 1 diabetes in an attempt to uncover possible positive outcomes of growth and optimism.Design: Interpretative phenomenological analysis (IPA) enabled the in-depth exploration of the journeys of a group of young female adults living with type 1 diabetes from distress to positive outcomes. Six participants between the ages of 18 and 25 were recruited from a Centre for Diabetes and Endocrinology, in Parktown, South Africa, to participate in semi-structured interviews about their meaning-making process.Results: Three superordinate themes emerged: (1) the process of reappraising a life with diabetes; (2) the development of diabetes as a lifestyle; and (3) positive outcomes of living with diabetes.Conclusion: Findings in this study demonstrate how the meaning-making process has a significant impact on positive adjustment to living with diabetes. While participants experienced distress, they reframed living with diabetes as an opportunity for empowerment and personal growth. Actively seeking and promoting of the positive outcomes of meaning-making could assist young adults to improve their quality of life while living with diabetes.

'It kinda sucks': Illness perception of a group of South African adolescents with type 1 diabetes mellitus.

BACKGROUND: Living with diabetes is challenging, especially for adolescents at risk of poor glycaemic control. Understanding the illness perceptions of this group is important to be able to develop interventions for this growing population in need. AIM: This study explored the illness perception amongst adolescents living with type 1 diabetes (T1D) and how these perceptions interacted with the management of T1D. SETTING: This study was conducted at a medical centre providing care for adolescents living with T1D in Parktown, South Africa. METHODS: A qualitative, explorative design with semi-structured interviews was followed. A non-random purposive sampling method was utilised. The illness perception amongst eight adolescents, aged 12-18 years, at risk of poor glycaemic control, was analysed through thematic analysis. RESULTS: Two subthemes related to illness perception were generated, namely (1) illness perception of T1D is negative and (2) living with T1D leads to a sense of being different. Furthermore, two subthemes were generated in relation to how illness perceptions interacted with diabetes management, namely (3) management of T1D is challenging and (4) management of T1D is motivated by fear. CONCLUSION: This group of adolescents with at-risk glycaemic control believed that T1D is difficult to manage, leading to a largely negative perception of the disease. This study contributes to the body of literature on adolescents where illness perception may play a role in adhering to diabetes care plans. This research may give additional insights into the awareness of illness perception in designing successful interventions.

Psychologists' experience of a malpractice complaint: Their relationship with and processes at the regulator.

BACKGROUND: Professional malpractice complaints in the South African health arena have increased over the last decade. There is a lack of research on how South African health practitioners experience professional malpractice complaints and complaint processes. AIM: This article reports on one aspect of the findings in a more extensive study relating to the complaint experience of psychology practitioners, namely how a group of psychology practitioners experienced their relationship with and the processes at the regulator during a malpractice complaint. The regulator refers to the professional registration body which manages complaints against practitioners. SETTING: The study included 10 registered South African psychologists who experienced a malpractice complaint. METHODS: After sampling, semi-structured interviews were conducted, audio-recorded and transcribed. The data were managed using interpretative phenomenological analysis (IPA) to elicit the personal, subjective experience of the individual participants. FINDINGS: Two superordinate themes and related subthemes emerged from the analysis. First, relating to the experience of the complaint procedures and processes, participants experienced an extended timeframe for complaint management, a lack of communication during complaint management, legal challenges during some disciplinary proceedings and some complaints as unjustified and frivolous. Second, participants were unsure of their relationship with the regulator. Their responses denoted instances of vulnerability and inequality during proceedings. CONCLUSIONS: The findings call for closer collaboration between the registration body and practitioners during complaints management, to eliminate vexatious complaints, to streamline processes and to encourage guidance of and support for the professional.

The effect of a serious game on empathy and prejudice of psychology students towards persons with disabilities.

BACKGROUND: Much has been done regarding the promotion of equality in rights in terms of legislation, but persons with disabilities remain marginalised in society. Negative attitudes and prejudice contribute towards numerous challenges for persons with disabilities. OBJECTIVES: This study investigated the level of empathy and prejudice of students towards persons with disabilities, and the effect of the use of a serious game to enhance empathy and reduce prejudice. METHOD: A randomised controlled experiment with pre-test, post-test and follow-up test was used. Availability sample (N = 83) of psychology university students (22% males; 78% females) was divided into an experimental group that played the serious game The World of Empa and two control groups. The first control group received texts on case studies and information on reacting in a sensitive and responsive way, and the second control group received no intervention. RESULTS: Participants have average levels of empathy (score: 32 to 52) and strong prejudice (score: 0.08 to -0.87) towards persons with disabilities. The intervention results in a slight short-term effect for prejudice and sub-scale measurements of empathy. A slight improvement was noted in participants' ability to transpose themselves imaginatively into the experience of disabled characters. CONCLUSION: The findings contribute to the understanding of empathy as a dynamic component that can be positively influenced by, for example, a serious game. These results have teaching implications on the facilitation of empathy. The short-term effect on empathy and prejudice towards persons with disabilities may contribute to bridge the inequality experienced by persons with disabilities. KEYWORDS: empathy; prejudice; serious games; persons with disabilities; psychology students.

Illness perception of adolescents with well-controlled type 1 diabetes mellitus.

In this study, to explore the illness perceptions of adolescents with well-controlled type 1 diabetes mellitus in South Africa, semi-structured interviews were conducted with nine, purposively selected adolescents (mean = 13.9 years; median = 12). Themes that emerged from the thematic analysis include the following: accepting diabetes and the diabetes care plan as part of their lives; viewing diabetes as manageable and as their responsibility; and the important role of gaining information on diabetes and diabetes management. These perceptions contributed to adherence to diabetes care plans and should be explored and developed among adolescents with type 1 diabetes mellitus to improve their diabetes management.

Novel application of Ki67 to quantify antigen-specific in vitro lymphoproliferation.

Antigen-specific proliferation is a critical function of memory T cells that is often utilised to measure vaccine immunogenicity and T cell function. We proposed that measurement of intracellular expression of the nuclear protein, Ki67, could reliably assess specific T cell proliferation in vitro. Ki67 was expressed in CD4+ and CD8+ T cells that had undergone in vitro proliferation after 6-day culture of human whole blood or PBMC with antigens. T cells cultured with no antigen did not express Ki67. When compared to current flow cytometry based proliferation assays, Ki67 detected proliferating cells with greater sensitivity than BrdU incorporation, whereas its sensitivity was similar to dye dilution of Oregon Green (OG), a CFSE derivative. Overall, the magnitude and cytokine expression profile of proliferating T cells detected by Ki67 expression correlated strongly with T cells detected with BrdU or OG. The intra-assay variability of Ki67 proliferation was 2-3% for CD4+ T cells, and 10-16% for CD8+ T cells. Finally, we demonstrate that the Ki67 assay detects tetanus toxoid-specific CD4+ T cell proliferation after infant vaccination with tetanus toxoid (TT). Overall our data suggest that intracellular Ki67 expression provides a specific, quantitative and reproducible measure of antigen-specific T cell proliferation in vitro.