Browsing by Author "Alan Stein"

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    Assessing the prevalence of young children living in households prepared for COVID-19 in 56 low- and middle-income countries
    (2022) Chunling Lu; Yiqun Luan; Sara N. Naicker; S. V. Subramanian; Jere R. Behrman; Jody Heymann; Alan Stein; Linda M. Richter
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    Association between fetal abdominal growth trajectories, maternal metabolite signatures early in pregnancy, and childhood growth and adiposity: prospective observational multinational INTERBIO-21st fetal study
    (2022-08-20) Jose Villar; Roseline Ochieng; Robert B Gunier; Aris T Papageorghiou; Stephen Rauch; Rose McGready; Julia M Gauglitz; Fernando C Barros; Manu Vatish; Michelle Fernandes; Victor Zammit; Verena I Carrara; Shama Munim; Rachel Craik; Hellen C Barsosio; Maria Carvalho; James A Berkley; Leila I Cheikh Ismail; Shane A Norris; Chrystelle O O Tshivuila-Matala; Francois Nosten; Eric O Ohuma; Alan Stein; Ann Lambert; Adele Winsey; Ricardo Uauy; Brenda Eskenazi; Zulfiqar A Bhutta; Stephen H Kennedy
    Background: Obesity predominantly affects populations in high-income countries and those countries facing epidemiological transition. The risk of childhood obesity is increased among infants who had overweight or obesity at birth, but in low-resource settings one in five infants are born small for gestational age. We aimed to study the relationships between: (1) maternal metabolite signatures; (2) fetal abdominal growth; and (3) postnatal growth, adiposity, and neurodevelopment. Methods: In the prospective, multinational, observational INTERBIO-21st fetal study, conducted in maternity units in Pelotas (Brazil), Nairobi (Kenya), Karachi (Pakistan), Soweto (South Africa), Mae Sot (Thailand), and Oxford (UK), we enrolled women (≥18 years, with a BMI of less than 35 kg/m2, natural conception, and a singleton pregnancy) who initiated antenatal care before 14 weeks' gestation. Ultrasound scans were performed every 5±1 weeks until delivery to measure fetal growth and feto-placental blood flow, and we used finite mixture models to derive growth trajectories of abdominal circumference. The infants' health, growth, and development were monitored from birth to age 2 years. Early pregnancy maternal blood and umbilical cord venous blood samples were collected for untargeted metabolomic analysis. Findings: From Feb 8, 2012, to Nov 30, 2019, we enrolled 3598 pregnant women and followed up their infants to 2 years of age. We identified four ultrasound-derived trajectories of fetal abdominal circumference growth that accelerated or decelerated within a crucial 20-25 week gestational age window: faltering growth, early accelerating growth, late accelerating growth, and median growth tracking. These distinct phenotypes had matching feto-placental blood flow patterns throughout pregnancy, and different growth, adiposity, vision, and neurodevelopment outcomes in early childhood. There were 709 maternal metabolites with positive effect for the faltering growth phenotype and 54 for the early accelerating growth phenotype; 31 maternal metabolites had a negative effect for the faltering growth phenotype and 76 for the early accelerating growth phenotype. Metabolites associated with the faltering growth phenotype had statistically significant odds ratios close to 1·5 (ie, suggesting upregulation of metabolic pathways of impaired fetal growth). The metabolites had a reciprocal relationship with the early accelerating growth phenotype, with statistically significant odds ratios close to 0.6 (ie, suggesting downregulation of fetal growth acceleration). The maternal metabolite signatures included 5-hydroxy-eicosatetraenoic acid, and 11 phosphatidylcholines linked to oxylipin or saturated fatty acid sidechains. The fungicide, chlorothalonil, was highly abundant in the early accelerating growth phenotype group. Interpretation: Early pregnancy lipid biology associated with fetal abdominal growth trajectories is an indicator of patterns of growth, adiposity, vision, and neurodevelopment up to the age of 2 years. Our findings could contribute to the earlier identification of infants at risk of obesity.
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    Digital delivery of behavioural activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAt study): protocol for a pilot randomised controlled trial
    (2022-12-05) Bianca D Moffett; Julia R Pozuelo; Alastair van Heerden; Heather A O'Mahen; Michelle Craske; Tholene Sodi; Crick Lund; Kate Orkin; Emma J Kilford; Sarah-Jayne Blakemore; Mahreen Mahmud; Eustasius Musenge; Meghan Davis; Zamakhanya Makhanya; Tlangelani Baloyi; Daniel Mahlangu; Gabriele Chierchia; Sophie L Fielmann; F Xavier Gómez-Olivé; Imraan Valodia; Stephen Tollman; Kathleen Kahn; Alan Stein
    Introduction Scalable psychological treatments to address depression among adolescents are urgently needed. This is particularly relevant to low-income and middle-income countries where 90% of the world’s adolescents live. While digital delivery of behavioural activation (BA) presents a promising solution, its feasibility, acceptability and effectiveness among adolescents in an African context remain to be shown. Methods and analysis This study is a two-arm singleblind individual-level randomised controlled pilot trial to assess the feasibility, acceptability and initial efficacy of digitally delivered BA therapy among adolescents with depression. The intervention has been coproduced with adolescents at the study site. The study is based in the rural northeast of South Africa in the Bushbuckridge subdistrict of Mpumalanga province. A total of 200 adolescents with symptoms of mild to moderately severe depression on the Patient Health Questionnaire Adolescent Version will be recruited (1:1 allocation ratio). The treatment group will receive BA therapy via a smartphone application (the Kuamsha app) supported by trained peer mentors. The control group will receive an enhanced standard of care. The feasibility and acceptability of the intervention will be evaluated using a mixed methods design, and signals of the initial efficacy of the intervention in reducing symptoms of depression will be determined on an intention-to-treat basis. Secondary objectives are to pilot a range of cognitive, mental health, risky behaviour and socioeconomic measures; and to collect descriptive data on the feasibility of trial procedures to inform the development of a further larger trial.
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    Effects of early-life poverty on health and human capital in children and adolescents: analyses of national surveys and birth cohort studies in LMICs
    (2022-04-30) Cesar G Victora; Fernando P Hartwig; Luis P Vidaletti; Reynaldo Martorell; Clive Osmond; Linda M Richter; Aryeh D Stein; Aluisio J D Barros; Linda S Adair; Fernando C Barros; Santosh K Bhargava; Bernardo L Horta; Maria F Kroker-Lobos; Nanette R Lee; Ana Maria B Menezes; Joseph Murray; Shane A Norris; Harshpal S Sachdev; Alan Stein; Jithin S Varghese; Zulfiqar A Bhutta; Robert E Black
    The survival and nutrition of children and, to a lesser extent, adolescents have improved substantially in the past two decades. Improvements have been linked to the delivery of effective biomedical, behavioural, and environmental interventions; however, large disparities exist between and within countries. Using data from 95 national surveys in low-income and middle-income countries (LMICs), we analyse how strongly the health, nutrition, and cognitive development of children and adolescents are related to early-life poverty. Additionally, using data from six large, long-running birth cohorts in LMICs, we show how early-life poverty can have a lasting effect on health and human capital throughout the life course. We emphasise the importance of implementing multisectoral anti-poverty policies and programmes to complement specific health and nutrition interventions delivered at an individual level, particularly at a time when COVID-19 continues to disrupt economic, health, and educational gains achieved in the recent past.
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    Effects of earlylife poverty on health and human capital in children and adolescents Analyses of national surveys and birth cohort studies in LMICs
    Cesar Victora; Fernando Hartwig; Luis Vidaletti; Reynaldo Martorell; LINDA RICHTER; Shane Norris; Alan Stein; et al. et al.
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    Efficacy of regular exercise during pregnancy on the prevention of postpartum depression
    CdeVN Coll; MR Dominigues; Alan Stein; BGC da Silva; DG Bassani; E et al
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    Executive function associated with sexual risk in young South African women: Findings from the HPTN 068 cohort
    (2018-04-02) Molly Rosenberg; Audrey Pettifor; Mihaela Duta; Nele Demeyere; Ryan G. Wagner; Amanda Selin; Catherine MacPhail; Oliver Laeyendecker; James P. Hughes; Alan Stein; Stephen Tollman; Kathleen Kahn
    Purpose Heightened sexual risk in adolescence and young adulthood may be partially explained by deficits in executive functioning, the set of cognitive processes used to make reasoned decisions. However, the association between executive function and sexual risk is understudied among adolescent girls and young women, particularly in low- and middle-income countries. Methods In a cohort of 853 young women age 18–25 in rural Mpumalanga province, South Africa, we evaluated executive function with three non-verbal cognitive tests: I. a rule-finding test, II. a trail-making test, and III. a figure drawing test. Using log-binomial regression models, we estimated the association between lower executive function test scores and indicators of sexual risk (unprotected sex acts, concurrent partnerships, transactional sex, and recent HSV-2 infection). Results In general, young women with lower executive function scores reported higher frequencies of sexual risk outcomes, though associations tended to be small with wide confidence intervals. Testing in the lowest quintile of Test I was associated with more unprotected sex [aPR (95% CI): 1.4 (1.0, 1.8)]. Testing in the lowest quintile of Test II was associated with more concurrent relationships and transactional sex [aPR (95% CI): 1.6 (1.1, 2.5) and 1.7 (1.3, 2.4), respectively], and testing in the lowest four quintiles of Test III was associated with more concurrent relationships [aPR (95% CI): 1.7 (1.0, 2.7)]. Conclusions These results demonstrate an association between low executive function and sexual risk in South African young women. Future work should seek to understand the nature of this association and whether there is promise in developing interventions to enhance executive function to reduce sexual risk.
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    Exploring the experiences of healthcare professionals in South Africa and Uganda around communicating with children about life-threatening conditions: a workshop-based qualitative study to inform the adaptation of communication frameworks for use in these settings
    (2022-12-15) Elizabeth Rapa; Jeffrey R Hanna; Teresa Pollard; Stephanie Santos-Paulo; Yasmin Gogay; Julia Ambler; Elizabeth Namukwaya; David Kavuma; Elizabeth Nabirye; Ruth Mary Kemigisha; Juliet Namyeso; Tracey Brand; Louise Walker; Beverley G Neethling; Julia Downing; Sue Ziebland; Alan Stein; Louise J Dalton
    Objectives This study aimed to explore how published communication frameworks could be amended to ensure applicability and cultural appropriateness for professionals to support family-centred conversations by investigating’ healthcare professionals’ (1) experiences of providing support to families when a caregiver or a dependent child (<18 years old) has a life-threatening condition, (2) perceived challenges for caregivers and healthcare professionals in communicating with children about illness, (3) perceptions of how clinicians could be equipped to facilitate conversations between caregivers and children about an adult or the child’s own life-threatening condition and (4) suggestions for amendments to previously published guidelines to ensure cultural relevance in South Africa and Uganda. Design A qualitative study involving two 2-day workshops with embedded focus group discussions, break out rooms and consensus discussions. Setting Health and social care and third sector organisations in South Africa and Uganda. Participants Thirty-two professionals providing care to families affected by life-threatening conditions in South Africa or Uganda who were aged 18 years or older and able to converse in English. Results Participants identified obstacles to having conversations with caregivers about children and to telling children about serious illness during consultations. These included patients’ beliefs about illness, medicine and death, language barriers between families and the healthcare team, and emotional and practical challenges for professionals in having these conversations. Culturally appropriate adaptations were made to previously published communication frameworks for professionals to support family-centred conversations. Conclusions Culturally sensitive communication frameworks could help healthcare professionals to talk with families about what children need to know when they or a caregiver have a serious illness. More broadly, effective communication could be facilitated by promoting healthcare professionals’ and communities’ understanding of the benefits of telling children about illness within the family. Together these strategies may mitigate the psychological impact of global disease on children and their families
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    Maternal alcohol use and childrens emotional and cognitive outcomes in rural South Africa
    Tamsen Rochat; Brian Houle; Alan Stein; J Mitchell; Ruth Bland
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    Maternal postnatal depression and offspring depression at age 24 years in a UK-birth cohort: the mediating role of maternal nurturing behaviours concerning feeding, crying and sleeping
    (2022-10-19) Iryna Culpin; Gemma Hammerton; Marc H Bornstein; Jon Heron; Jonathan Evans; Tim Cadman; Hannah M Sallis; Kate Tilling; Alan Stein; Alex S F Kwong; Rebecca M Pearson
    Background: Maternal postnatal depression (PND) is a risk factor for offspring depression in adulthood. However, few longitudinal studies have examined the role of maternal nurturing parenting behaviours in the association between maternal PND and offspring depression in adulthood. Methods: We examined pathways from maternal PND measured using self-reported Edinburgh Postnatal Depression Scale at 8 weeks to offspring ICD-10 depression diagnosed using the Clinical Interview Schedule-Revised computerised assessment at 24 years through maternal-reported nurturing behaviours concerning feeding, sleeping and crying measured from pregnancy to age 3 years 6 months in 5,881 members of the UK-based birth cohort study, the Avon Longitudinal Study of Parents and Children. Results: The fully adjusted model revealed an indirect effect from PND to adult offspring depression through the combination of all parenting factors (probit regression coefficient [ B]=0.038, 95% confidence interval [CI] 0.005, 0.071); however, there was no evidence of a direct effect from early maternal PND to offspring depression once the indirect effect via parenting factors was accounted for ( B=0.009, 95%CI -0.075, 0.093). Specificity analyses revealed indirect effects through maternal worries about feeding ( B=0.019, 95%CI 0.003, 0.035, p=0.010) and maternal perceptions and responses to crying ( B=0.018, 95%CI 0.004, 0.032, p=0.012). Conclusions: The adverse impact of maternal PND on offspring depression in early adulthood was explained by maternal nurturing behaviours concerning feeding, crying and sleeping in early childhood. Residual confounding and measurement error likely limit reliable conclusions. If found causal, interventions providing support to reduce worries around maternal nurturing behaviours and treating depression could reduce adverse outcomes in adult offspring of depressed mothers.
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    Normative spatiotemporal fetal brain maturation with satisfactory development at 2 years
    (NATURE PUBLISHING GROUP) A.I.L Namburete; B.W Papież; M Fernandes; M.K Wyburd; Alan Stein; E et al
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    Obstacles and facilitators to communicating with children about their parents’ mental illness: a qualitative study in a sub‑district of Mpumalanga, South Africa
    (2023) Lucy Dean; Hadassah Buechner; Bianca Moffett; Meriam Maritze; Louise J. Dalton; Jeffrey R. Hanna; Elizabeth Rapa; Alan Stein; Stephen Tollman; Kathleen Kahn
    Background Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents’ symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts. Methods A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis. Results Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals’ concerns for the wellbeing and future mental health of patients’ children, as well as their hopes for increased mental health awareness amongst future generations. Conclusions This study provides insight into healthcare professionals’ attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent’s mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational
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    Prevalence and risk factors for postnatal mental health problems in mothers of infants admitted to neonatal care: analysis of two population-based surveys in England
    (2023) Jenny Gong; Gracia Fellmeth; Maria A. Quigley; Chris Gale; Alan Stein; Fiona Alderdice; Siân Harrison
    Background Previous research suggests that mothers whose infants are admitted to neonatal units (NNU) experience higher rates of mental health problems compared to the general perinatal population. This study examined the prevalence and factors associated with postnatal depression, anxiety, post-traumatic stress (PTS), and comorbidity of these mental health problems for mothers of infants admitted to NNU, six months after childbirth. Methods This was a secondary analysis of two cross-sectional, population-based National Maternity Surveys in England in 2018 and 2020. Postnatal depression, anxiety, and PTS were assessed using standardised measures. Associations between sociodemographic, pregnancy- and birth-related factors and postnatal depression, anxiety, PTS, and comorbidity of these mental health problems were explored using modifed Poisson regression and multinomial logistic regression. Results Eight thousand fve hundred thirty-nine women were included in the analysis, of whom 935 were mothers of infants admitted to NNU. Prevalence of postnatal mental health problems among mothers of infants admitted to NNU was 23.7% (95%CI: 20.6–27.2) for depression, 16.0% (95%CI: 13.4–19.0) for anxiety, 14.6% (95%CI: 12.2–17.5) for PTS, 8.2% (95%CI: 6.5–10.3) for two comorbid mental health problems, and 7.5% (95%CI: 5.7–10.0) for three comorbid mental health problems six months after giving birth. These rates were consistently higher compared to mothers whose infants were not admitted to NNU (19.3% (95%CI: 18.3–20.4) for depression, 14.0% (95%CI: 13.1–15.0) for anxiety, 10.3% (95%CI: 9.5–11.1) for PTS, 8.5% (95%CI: 7.8–9.3) for two comorbid mental health problems, and 4.2% (95%CI: 3.6–4.8) for three comorbid mental health problems six months after giving birth. Among mothers of infants admitted to NNU (N=935), the strongest risk factors for mental health problems were having a long-term mental health problem and antenatal anxiety, while social support and satisfaction with birth were protective. Conclusions Prevalence of postnatal mental health problems was higher in mothers of infants admitted to NNU, compared to mothers of infants not admitted to NNU six months after giving birth. Experiencing previous mental health problems increased the risk of postnatal depression, anxiety, and PTS whereas social support and satisfaction with birth were protective. The fndings highlight the importance of routine and repeated mental health assessments and ongoing support for mothers of infants admitted to NNU.
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    The adolescent HIV executive function and drumming (AHEAD) study, afeasibility trial of a group drumming intervention amongst adolescents with HIV
    (2023-04-11) Kirsten Rowe; Julia Ruiz Pozuelo; Alecia Nickless; Absolum David Nkosi; Andeline Dos Santos; Kathleen Kahn; Stephen Tollman; Ryan G Wagner; Gaia Scerif; Alan Stein
    AHEAD feasibility trial assessed the feasibility and acceptability of an 8-session group drummingprogramme aiming to improve executive function, depression and anxiety symptoms, andperceived social support in adolescents living with HIV in a rural low-income South Africansetting. Sixty-eight 12- to 19-year-old adolescents participated. They were individuallyrandomised. The intervention arm (n= 34) received weekly hour-long group drumming sessions.Controls (n= 34) received no intervention. Feasibility and acceptability were assessed usingrates of: enrolment; retention; attendance; logistical problems; adolescent-reportedacceptability. Secondary measures included:five Oxford Cognitive Screen-Executive Function(OCS-EF) tasks; two Rapid Assessment of Cognitive and Emotional Regulation (RACER) tasks; theSelf-Reporting Questionnaire-20 (SRQ-20) measuring depression and anxiety symptoms; theMultidimensional Scale of Perceived Social Support (MSPSS). All feasibility criteria were withingreen progression limits. Enrolment, retention, and acceptability were high. There was a positiveeffect on adolescent depressed mood with signal for a working memory effect. There were nosignificant effects on executive function or socio-emotional scales. Qualitativefindingssuggested socio-emotional benefits including: group belonging; decreased internalised stigma;improved mood; decreased anxiety. Group drumming is a feasible and acceptable interventionamongst adolescents living with HIV in rural South Africa. A full-scale trial is recommended.
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    The impact of the Covid-19 pandemic on postnatal depression: analysis of three population-based national maternity surveys in England (2014–2020)
    (2023-05-15) Siân Harrison; Maria A. Quigley; Gracia Fellmeth; Alan Stein; Fiona Alderdice
    Background Few studies have evaluated postnatal depression before and during the Covid-19 pandemic using comparable data across time. We used data from three national maternity surveys in England to compare prevalence and risk factors for postnatal depression before and during the pandemic. Methods Analysis was conducted using population-based surveys carried out in 2014 (n = 4571), 2018 (n = 4509), and 2020 (n = 4611). Weighted prevalence estimates for postnatal depression (EPDS score ≥13) were compared across surveys. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the association between sociodemographic, pregnancy- and birth-related, and biopsychosocial factors, and postnatal depression. Findings Prevalence of postnatal depression increased from 10.3% in 2014 to 16.0% in 2018 (difference = +5.7% (95% CI: 4.0–7.4); RR = 1.55 (95% CI: 1.36–1.77)) and to 23.9% in 2020 (difference = +7.9% (95% CI: 5.9–9.9); RR = 1.49 (95% CI: 1.34–1.66)). Having a long-term mental health problem (aRR range = 1.48–2.02), antenatal anxiety (aRR range = 1.73–2.12) and antenatal depression (aRR range = 1.44–2.24) were associated with increased risk of postnatal depression, whereas satisfaction with birth (aRR range = 0.89–0.92) and social support (aRR range = 0.73–0.78) were associated with decreased risk before and during the pandemic. Interpretation This analysis indicates that Covid-19 had an important negative impact on postnatal women’s mental health and may have accelerated an existing trend of increasing prevalence of postnatal depression. Risk factors for postnatal depression were consistent before and during the pandemic. Timely identification, intervention and followup are key to supporting women at risk, and it is essential that mechanisms to support women are strengthened during times of heightened risk such as the pandemic.
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    The power of smiling the adult brain networks underlying learned infant emotionality
    Alan Stein; EA Stark; J Cabral; MM Riem; MH van Ijzendoorn; ML Kringelbach