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To examine the child outcomes at 18-months post-birth of a population cohort of women with antenatal depressed mood, half of whom were randomly chosen to receive perinatal home visits from community health workers during pregnancy.
Pregnant women in 24 neighbourhoods (98% participation) were randomised by neighbourhood to: (1) standard clinic care (SC; 12 neighbourhoods; n = 594) or (2) the Philani Intervention Program, a home visiting intervention plus standard care (12 neighbourhoods; n = 644). The physical and cognitive outcomes of children of mothers with antenatally depressed mood (Edinburg Perinatal Depression Scale >13) in the intervention condition were compared at 18-months post-birth to children of mothers without depressed mood in pregnancy in both conditions.
More than a third of mothers had heightened levels of antenatal depressed mood (35%), similar across conditions. Antenatal depressed mood was significantly associated with being a mother living with HIV, using alcohol and food insecurity. At 18-months, the overall cognitive and motor scale scores on the Bayley Scales of Development were similar. However, 10.3% fewer children of mothers with antenatal depressed mood in the intervention condition had cognitive scores on the Bayley Scales that were less than 85 (i.e., s.d. = 2 lower than normal) compared with children of mothers with antenatal depressed mood in the SC condition. Intervention children of mothers with antenatal depressed mood were also significantly less likely to be undernourished (Weight-for-Age Z-scores < −2).
Cognitive development and child growth among children born to mothers with antenatal depressed mood can be improved by mentor mother home visitors, probably resulting from better parenting and care received early in life.
A considerable body of evidence suggests that early caregiving may affect the short-term functioning and longer term development of the hypothalamic–pituitary–adrenocortical axis. Despite this, most research to date has been cross-sectional in nature or restricted to relatively short-term longitudinal follow-ups. More important, there is a paucity of research on the role of caregiving in low- and middle-income countries, where the protective effects of high-quality care in buffering the child's developing stress regulation systems may be crucial. In this paper, we report findings from a longitudinal study (N = 232) conducted in an impoverished periurban settlement in Cape Town, South Africa. We measured caregiving sensitivity and security of attachment in infancy and followed children up at age 13 years, when we conducted assessments of hypothalamus–pituitary–adrenocortical axis reactivity, as indexed by salivary cortisol during the Trier Social Stress Test. The findings indicated that insecure attachment was predictive of reduced cortisol responses to social stress, particularly in boys, and that attachment status moderated the impact of contextual adversity on stress responses: secure children in highly adverse circumstances did not show the blunted cortisol response shown by their insecure counterparts. Some evidence was found that sensitivity of care in infancy was also associated with cortisol reactivity, but in this case, insensitivity was associated with heightened cortisol reactivity, and only for girls. The discussion focuses on the potentially important role of caregiving in the long-term calibration of the stress system and the need to better understand the social and biological mechanisms shaping the stress response across development in low- and middle-income countries.
The Olympic sporting context of 1908, with its tension between nationalistic competition and high-minded amateurism, provides insight as well into the transatlantic relationship between Great Britain and the United States during the presidency of Theodore Roosevelt and in the years following the prime ministerial tenure of Britain's Arthur Balfour. The article explores this relationship through two high-profile sports events—the 1908 London Olympic Games and its predecessor games in St. Louis in 1904—to consider how governing political and social networks in the two countries viewed themselves and one another and related to one another. The positions and values of U.S. President Theodore Roosevelt and British Prime Minister Arthur Balfour are reevaluated in this context. The article concludes that the 1908 Olympics in many ways typified Anglo-American relations during the opening decade of the twentieth century. Strenuous competition between the two nations was accepted by both parties as a means to achieve a measure of superiority over the other for the broader audience in each nation and also across the globe.
Few studies have evaluated the implementation and impact of real-world mental health programmes delivered at scale in low-resource settings.
To describe the cross-country research methods used to evaluate district-level mental healthcare plans (MHCPs) in Ethiopia, India, Nepal, South Africa and Uganda.
Multidisciplinary methods conducted at community, health facility and district levels, embedded within a theory of change.
The following designs are employed to evaluate the MHCPs: (a) repeat community-based cross-sectional surveys to measure change in population-level contact coverage; (b) repeat facility-based surveys to assess change in detection of disorders; (c) disorder-specific cohorts to assess the effect on patient outcomes; and (d) multilevel case studies to evaluate the process of implementation.
To evaluate whether and how a health-system-level intervention is effective, multidisciplinary research methods are required at different population levels. Although challenging, such methods may be replicated across diverse settings.
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.
We describe epidemiological trends in Mycobacterium bovis infection in an undisturbed wild badger (Meles meles) population. Data were derived from the capture, clinical sampling and serological testing of 1803 badgers over 9945 capture events spanning 24 years. Incidence and prevalence increased over time, exhibiting no simple relationship with host density. Potential explanations are presented for a marked increase in the frequency of positive serological test results. Transmission rates (R0) estimated from empirical data were consistent with modelled estimates and robust to changes in test sensitivity and the spatial extent of the population at risk. The risk of a positive culture or serological test result increased with badger age, and varied seasonally. Evidence consistent with progressive disease was found in cubs. This study demonstrates the value of long-term data and the repeated application of imperfect diagnostic tests as indices of infection to reveal epidemiological trends in M. bovis infection in badgers.
The behaviour of certain infected individuals within socially structured populations can have a disproportionately large effect on the spatio-temporal distribution of infection. Endemic infection with Mycobacterium bovis in European badgers (Meles meles) in Great Britain and Ireland is an important source of bovine tuberculosis in cattle. Here we quantify the risk of infection in badger cubs in a high-density wild badger population, in relation to the infection status of resident adults. Over a 24-year period, we observed variation in the risk of cub infection, with those born into groups with resident infectious breeding females being over four times as likely to be detected excreting M. bovis than cubs from groups where there was no evidence of infection in adults. We discuss how our findings relate to the persistence of infection at both social group and population level, and the potential implications for disease control strategies.
Transmission X-ray diffraction is demonstrated as a new tool for examining daughter minerals within sub-micrometre-size fluid inclusions in fibrous diamond. In transmission geometry, the X-ray beam passes through the sample, interacting with a volume of material. Fibrous diamonds from Mbuji-Mayi. Democratic Republic of Congo; the Wawa area, Ontario, Canada; and the Panda kimberlite, Ekati Mine, Northwest Territories and the Jericho kimberlite, Nunavut, Canada were analysed using X-rays from a high-brilliance lab source and a synchrotron source. Daughter minerals present include the mica-group mineral celadonite, sylvite, halite, dolomite and other carbonates. This represents the first positive identification of halide minerals in fibrous diamond. Mineral inclusions such as forsteritic olivine and pyrope garnet were also found. Unexpectedly, daughter minerals were identified in only ten of the 38 diamonds analysed, despite their concentrations being greater than experimentally proven detection limits. The presence of significant amounts of amorphous or dissolved material appears unlikely, but cannot be ruled out. Alternatively, the results may indicate a wide variety of related daughter minerals, such that most phases fall below the detection limits. Transmission X-ray diffraction should be applied cautiously to the study of fibrous diamond, as it provides an incomplete account of the fluid-inclusion mineralogy.
In an investigation of impetigo among troops, carried out in 1941, nearly half of the strains of Staphylococcus aureus isolated from the lesions had the ability to inhibit the growth of corynebacteria on solid media. A much smaller proportion of strains from other superficial lesions and from nose and throat swabs had this ability, and strains from deep suppurative lesions were uniformly negative.
Three-quarters of Staph. aureus strains isolated from schoolchildren with impetigo in Lancashire in 1953 and early 1954 were of one variety, which could be denned by its susceptibility to typing phages (‘type 71’).
Nearly 90 % of ‘type 71’ staphylococci, and very few others, produced a narrow, sharp zone of inhibition of Corynebacterium diphtheriae mitis on solid media.
A small number of other staphylococci, mainly non-typable or unclassifiable strains, produced a wider, hazy zone of inhibition.
The majority of the impetigo staphylococci were penicillin-resistant, and most of the resistant strains were members of ‘type 71’. However, ‘type 71’ gave rise to only a small proportion of the penicillin-resistant hospital infections occurring in the same district at the same time.
Three-quarters of the Str. pyogenes strains from impetigo lesions belonged to one of two groups of closely related serological types, one of which was rarely encountered in other situations.
A method is described for the testing of strains of Sh. sonnei for antibiotic resistance, colicine type and drug resistance transfer using a multiple inoculator.
The examination of 731 strains of Sh. sonnei isolated from convalescent cases and their family contacts showed that about 5% of individuals were excreting organisms which differed from the infecting strain by a single transferable antibiotic resistance determinant. It is suggested that the acquisition of such resistance may occur in 13% of family incidents.
The colicine type and antibiotic resistance have been determined on strains of Sh. sonnei derived from 9419 incidents of Sonne dysentery in London between October 1956 and March 1965.
The most striking observation has been the appearance of strains with patterns of colicine production and antibiotic resistance new to the area. These changes are best regarded as a result of the interaction and transfer of characters between Sh. sonnei and other intestinal organisms.
The general tendency has been for strains of Sh. sonnei to become increasingly resistant to antibiotics but this has not been an uninterrupted process. The proportion of drug-resistant strains at any one time depended on the properties of the current epidemic strain.
Spread of Sonne dysentery was essentially local, but some strains of Sh. sonnei were found to spread much more widely than others. Most, but not all, of the strains resistant to streptomycin and tetracycline possessed only limited powers of spreading.
Quadruple vaccine containing 75 D antigen units of killed type 1 poliovirus was given to children at ages 2, 3 and 4 months followed by a booster dose at 15 months.
The serological response to the primary course was difficult to assess owing to maternal antibody. Antibody titres to the type 1 component after the booster dose were very satisfactory and about 10 times higher than those observed in a similar group of children given attenuated vaccine. Response to the poliovirus types 2 and 3 in the quadruple vaccine was less satisfactory.
Graded doses of attenuated poliovirus type 1 were fed to the children 2 months after the primary course and 1 month after the booster dose. Children who had received no poliovaccine and children immunized with attenuated vaccine were included for comparison.
Immunization with killed vaccine did not greatly affect the size of the minimal infecting dose of live virus but reduced both the duration of the subsequent infection and the titre of virus in the faeces.
The epidemiological significance of these findings is discussed.
For a period of a year the total count, Coli-aerogenes count and turbidity were determined on samples of sewage and effluent taken every week from pilot-scale percolating filters treating domestic sewage. The eight filters contained four types of filtering medium in two sizes.
Numbers of coliform bacteria in the settled sewage were much higher during the warmer months but the total count showed no regular seasonal variation. Treatment in all the filters reduced the numbers of bacteria in both groups by over 95%. In general the reductions in numbers of bacteria and in numbers of all particles in suspension were proportional to the total area of filtering medium with which the sewage came into contact. The probability of discharging more than 10,000 coli-aerogenes per ml. ranged from 10% in the most efficient to 90 % in the least efficient filter.
Experiments in which Serratia indica was added to the influent sewage showed that only 0·4 % were recovered in the settled effluent after 24 hr. Treatment in the filters had little selective action on the different types of coliform bacteria.
This paper is published by permission of the Department of Scientific and Industrial Research.
The incidence of antibiotic resistant strains of Sh. sonnei isolated in the London area is described. Strains were tested for their ability to transfer resistance to Most strains were resistant to sulphonamide and this resistance was transferable.
An increasing proportion of strains was resistant to 800 µg./ml. of streptomycin, but transferable streptomycin resistance was less common and often associated with tetracycline resistance.
The proportion of strains resistant to tetracycline fluctuated but this resistance was always transferred.
Ampicillin resistance was common; only those strains resistant to 500µg./ml. transferred this resistance.