Browsing by Author "Alan Stein"

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A videofeedback parenting intervention to prevent enduring behavior problems in atrisk children aged 1236 months the Healthy Start Happy Start RCT
C O'Farrelly; B Barker; H Watt; D Babalis; E et al; Alan Stein
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
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.
Atlantoaxial subluxation and Down syndrome: a cross sectional analysis
Alan Stein; M Merckling; S Vazquez; B Nolan; G Subah; E et al
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.
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.
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.
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
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.
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
Factors associated with posttraumatic stress and anxiety among the parents of babies admitted to neonatal care a systematic review
(BIOMED CENTRAL LTD) R Malouf; S Harrison; Victoria Pilkington; Charles Opondo; Alan Stein; et.al et.al
Impact of the COVID19 pandemic on anxiety and depression symptoms of young people in the global south Evidence from a fourcountry cohort study
Alan Stein; Catherine Porter; Marta Favara; Annina Favara; Douglas Scott; E et al
The impact of the Covid19 pandemic on postnatal anxiety and posttraumatic stress Analysis of two populationbased national maternity surveys in England
(ELSEVIER SCIENCE BV) S Harrison; M Quigley; G Fellmeth; Alan Stein; S Ayers; F Alderdice
Investigating the role of friendship interventions on the mental health outcomes of adolescents a scoping review of range and systematic reviews of effectiveness
(MDPI AG) T Manchanda; Alan Stein; M Fazel
Maternal alcohol use and childrens emotional and cognitive outcomes in rural South Africa
Tamsen Rochat; Brian Houle; Alan Stein; J Mitchell; Ruth Bland
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.
A NarrativeGamified Mental Health App Kuamsha for Adolescents in Uganda Mixed Methods Feasibility and Acceptability Study
Ruiz Pozuelo; C Nabulumba; D Sikoti; M Davis; L Gumikiriza-Onoria; Bianca Moffett; Alastair Van Heerden; E et al; Alan Stein
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
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
Prevalence and factors associated with postpartum post traumatic stress in a popultaionbased maternity survey in England
SE Harrison; S Ayers; MA Quigley; Alan Stein; F Alderdice