Depression And HIV/TB In Southern Africa: A Mixed Method Evaluation of An Integrated Primary Care Mental Health Programme In Eswatini

Background: Depression and comorbidity with chronic illnesses is common in Southern Africa, yet there are major treatment gaps. This study evaluates the intervention ‘Healthy Activity Program’ to bridge this gap, which involves training non-specialist nurses in depression: including identification, counselling based on behavioural activation theory and structured referral. This intervention aims to be integrated into routine primary healthcare services for HIV/TB. The patient cohort were people living with HIV and/or tuberculosis (TB) (PLHIV/TB) in rural Eswatini. Aims: To assess the feasibility and acceptability of this intervention and concepts of depression in this setting.Methods: This is a pragmatic mixed methods evaluation of a pilot integrated service.Results: 324 PLHIV/TB were screened for depression, with 19% (62/324) screening positive. Attendance to counselling declined over time, with 16/62 attending the minimum 5 sessions. Qualitative results indicated acceptability, yet concerns around feasibility. Conclusions: The ‘Healthy Activity Program’ represents a promising option to manage the treatment gap for depression in PLHIV/TB. However, task-shifting onto non-specialist healthcare professionals with the aim to integrate care for these conditions in primary care, without increasing staff capacity, is a barrier to implementation. Realistic and pragmatic assessments of capacity and workforce are essential.

Recent Advances in the Production of Exopolysaccharide (EPS) from Lactobacillus spp. and Its Application in the Food Industry: A Review

Exopolysaccharide (EPS) show remarkable properties in various food applications. In this review paper, EPS composition, structural characterization, biosynthesis pathways, and recent advancements in the context of application of EPS-producing Lactobacillus spp. in different food industries are discussed. Various chemical and physical properties of Lactobacillus EPS, such as the structural, rheological, and shelf-life enhancement of different food products, are mentioned. Moreover, EPSs play a characteristic role in starter culture techniques, yogurt production, immunomodulation, and potential prebiotics. It has been seen that the wastes of fermented and non-fermented products are used as biological food for EPS extraction. The main capabilities of probiotics are the use of EPS for technological properties such as texture and flavor enhancement, juiciness, and water holding capacities of specific food products. For these reasons, EPSs are used in functional and fermented food products to enhance the healthy activity of the human digestive system as well as for the benefit of the food industry to lower product damage and increase consumer demand. Additionally, some pseudocereals such as amaranth and quinoa that produce EPS also play an important role in improving the organoleptic properties of food-grade products. In conclusion, more attention should be given to sustainable extraction techniques of LAB EPS to enhance structural and functional use in the developmental process of food products to meet consumer preferences.

Interventional Indirect Effects: A Novel Approach to Optimise Complex Psychological Therapies to Treat Depression for Scale-up in Goa, India

Introduction: Understanding how and under what circumstances complex psychological therapies work (or not) is important to bring evidence-informed intervention to scale, especially in resource poor settings. However, current methods do not apply methodology that account for the underlying complexity of these interventions including the interplay between implementation outcomes, implementation strategies and mechanisms. Here we apply a robust mediation analysis to address these issues to data from the Healthy Activity Program (HAP) trial –a psychological intervention for depression delivered using task-shifting with lay counsellors in Goa India.Methods: Interventional in(direct) effects were used to simultaneously decompose the total effect of the intervention on depression symptoms measured through the Patient Health Questionnaire (PHQ-9). The following indirect effects were considered: fidelity of receipt including number of sessions and homework completed; behavioural activation according to an adapted version of the Behavioural Activation for Depression Short Form (BADS-SF), and extra sessions offered to participants who did not respond to the intervention. Results: Of the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.2, 95% bias-corrected CI: -3.2, -0.8), 45% was mediated through improved levels of behavioural activation (-1.0, -1.3, -0.6). There was little evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment. ConclusionsFindings from our analyses have demonstrated how interventional (in)direct effects can be applied to understand how implementation research programmes can be optimised for scale-up. Our results highlight the importance of sessions focusing on behavioural activation to improve symptoms of depression. Targeting non-responders with strategies other than extra therapy sessions has the potential to improve depression outcomes at a population level.

Reviewing the Benefits of Grazing/Browsing Semiarid Rangeland Feed Resources and the Transference of Bioactivity and Pro-Healthy Properties to Goat Milk and Cheese: Obesity, Insulin Resistance, Inflammation and Hepatic Steatosis Prevention

The rangeland is an ecological resource that provides multiple benefits for environment and agriculture. Grazing/browsing on rangelands is a useful and inexpensive means to produce food derived from animal products. The aim of this study was to review the benefits of producing milk and cheese under this system in terms of bioactivity and the health benefits of their consumption in model animals. To conduct this review, we particularly considered the experiments that our research group carried out along the last fifteen years at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico. Firstly, we examined the forages consumed by goats on the rangelands in terms of plant bioactive compound occurrence and their concentration. Further, goat milk and cheese coming from (1) grazing animals, (2) animals managed indoors, and from (3) animals managed indoor supplemented with rich plant bioactive compounds, were analyzed. Milk was discussed to modulate the negative effects of high-fat diets in mice. Forages consumed by goats on the rangelands showed a close correlation between antioxidant activity assessed by the DPPH+ radical with total flavonoid and total polyphenol contents (TPC). Milk concentration of PUFA, MUFA, and n-3 fatty acids from grazing goats (4.7%, 25.2%, and 0.94% of FAME) was higher than milk from goats fed indoor diets (ID). Similar results were shown in cheese. TPC was higher in cheese manufactured with milk from grazing goats (300 mg of GAE/kg of cheese) when compared to cheese from milk goats fed ID (60 mg of GAE/of cheese). Acacia pods are a semiarid rangeland feed resource that transfers pro-healthy activity, inhibited in vitro lipid peroxidation (inhibition of TBARS formation) and diminished the damage induced by reactive oxygen species (ROS). Additionally, in vivo assessment revealed that Acacia species increased free radical scavenging (DPPH), oxygen radical absorbance capacity, and anti-inflammatory activity. The results highlight that grazing/browsing practices are superior to indoor feeding in order to promote the transference of bioactive compounds from vegetation to animal tissue, and finally to animal products. Grazing management represents a better option than indoor feeding to enhance bioactivity of milk and cheese. Supplementation with rich-bioactive compound forages increased total polyphenol, hydroxycinnamic acids, and flavonoid concentrations in milk and cheese. The consumption of goat milk prevents obesity, insulin resistance, inflammation, and hepatic steatosis while on a high-fat diet induced obesity in mice.

Causal meditation analysis to understand how different components of a complex psychological intervention improved symptoms (or not) of depression in Goa, India

BackgroundUnderstanding how and under what circumstances a highly effective psychological intervention, improved symptoms of depression is important to bring this evidence-informed intervention to scale, particularly in resource-poor settings. We aim to estimate the indirect effects of potentially important mediators to improve symptoms of depression in the Healthy Activity Program (HAP) trial.MethodsInterventional in(direct) effects were used to simultaneously decompose the total effect of the intervention on depression symptoms measured through the Patient Health Questionnaire (PHQ-9). The following indirect effects were considered: characteristics of sessions including the number of sessions and homework completed; behavioural activation according to an adapted version of the Behavioural Activation for Depression Short Form (BADS-SF), and extra sessions offered to participants who did not respond to the intervention.ResultsOf the total effect of the intervention measured through the difference in PHQ-9 scores between treatment arms (mean difference: -2.2, 95% bias-corrected CI: -3.2, -0.8), 45% was mediated through improved levels of behavioural activation (−1.0, -1.3, -0.6). There was no evidence to support the mediating role of characteristics of the sessions nor the extra sessions offered to participants who did not respond to the treatment.ConclusionsFindings from our robust mediation analyses, confirmed the importance of behavioural activation in improving depression symptoms. Contrary to published literature, our findings suggest that neither the number of sessions nor proportion of homework completed, improved outcomes. Moreover, results indicate that the extra sessions were insufficient to improve symptoms of depression for participants who did not respond to the intervention.

Impact of COVID-19 restrictions on preschool children’s eating, activity and sleep behaviours: a qualitative study

ObjectivesIn spring 2020, the first COVID-19 national lockdown placed unprecedented restrictions on the behaviour and movements of the UK population. Citizens were ordered to ‘stay at home’, only allowed to leave their houses to buy essential supplies, attend medical appointments or exercise once a day. We explored how lockdown and its subsequent easing changed young children’s everyday activities, eating and sleep habits to gain insight into the impact for health and well-being.DesignIn-depth qualitative interviews; data analysed using thematic analysis.SettingSouth West and West Midlands of England.ParticipantsTwenty parents (16 mothers; 4 fathers) of preschool-age children (3–5 years) due to start school in September 2020. Forty per cent of the sample were from Black, Asian or minority ethnic backgrounds and half lived in the most deprived areas.ResultsChildren’s activity, screen time, eating and sleep routines had been disrupted. Parents reported children ate more snacks, but families also spent more time preparing meals and eating together. Most parents reported a reduction in their children’s physical activity and an increase in screen time, which some linked to difficulties in getting their child to sleep. Parents sometimes expressed guilt about changes in activity, screen time and snacking over lockdown. Most felt these changes would be temporary, though others worried about re-establishing healthy routines.ConclusionsParents reported that lockdown negatively impacted on preschool children’s eating, activity and sleep routines. While some positive changes were identified, many participants described lack of routines, habits and boundaries which may have been detrimental for child health and development. Guidance and support for families during COVID-19 restrictions could be valuable to help maintain healthy activity, eating, screen time and sleeping routines to protect child health and ensure unhealthy habits are not adopted.

‘I JUST WANT TO RUN’: how recreational runners perceive and deal with injuries

Running injuries impact the health gains achieved through running and are linked to drop-out from this otherwise healthy activity. The need for effective prevention is apparent, however, implementation of preventive measures implies a change in runners’ behaviour. This exploratory qualitative study aimed to explore Dutch recreational runners’ perception on injuries, injury occurrence and prevention. An interpretative paradigm underpins this study. We conducted 12 individual semistructured interviews with male (n=6) and female runners (n=6). Through a constant comparative data analysis, we developed a conceptual model to illustrate the final product of the analysis and represent the main themes’ connection. We present a framework that describes the pathway from load to injury and the self-regulatory process controlling this pathway. Runners mentioned that pain is not necessarily an injury, and they usually continue running. Once complaints become unmanageable and limit the runner’s ability to participate, an injury was perceived. Based on our outcomes, we recommend that preventive strategies focus on the self-regulation by which runners manage their complaints and injuries—providing information, advice and programmes that support the runner to make well-informed, effective decisions.

Moving Together: Understanding Parent Perceptions Related to Physical Activity and Motor Skill Development in Preschool Children

Background: Establishing physical activity (PA) and motor behaviors in early childhood are important for developing healthy activity behaviors. Parents play a central role in shaping young children’s PA and fundamental motor skills (FMS). This qualitative study explored parents’ attributes, values, perceptions, and practices related to PA and FMS. Methods: Thirty-one parents (26 mothers) of preschool-aged children participated in semi-structured in-person interviews. Interviews were audio-recorded, transcribed verbatim, coded and analyzed using an iterative approach. Results: Four themes related to PA and FMS emerged: (1) parent attributes; (2) parent–child interactions; (3) parent perception of children’s attributes; and (4) parenting practices. Although most parents enjoyed playing with their child, some did not realize the importance of engaging in PA with their child and even believed that FMS are naturally developed. Parents indicated that children’s temperament may influence their preference for practicing motor skills. Conclusions: Social support and positive parenting practices, including encouragement, monitoring, logistical support, co-participation, and facilitation, are important for the development of PA and FMS. The findings add emphasis to the importance of parents’ role in the development of young children’s PA and FMS, and they inform future strategies aiming to promote young children’s activity behaviors.

Measuring Early Childhood Educators’ Physical Activity and Sedentary Behavior–Related Self-Efficacy: A Systematic Review of Tools

Early childhood educators’ (ECEs) self-efficacy is often predictive of their ability and likelihood of promoting healthy activity behaviors in childcare settings. To date, ECEs’ physical activity and sedentary behavior–related self-efficacy has been measured in a variety of ways in childcare-based research, creating difficulty when comparing across studies. To identify the different approaches ECEs’ self-efficacy is assessed, the current study aimed to compare all existing tools that quantitatively measure physical activity and sedentary behavior–related self-efficacy of pre- and in-service ECEs. Seven online databases were searched for original, peer-reviewed, English-written journal articles. Articles were deemed eligible if they employed a tool which measured physical activity and/or sedentary behavior–related self-efficacy of pre- or in-service ECEs. A total of 16 studies were included in this review, and 13 unique tools were identified. All tools measured task self-efficacy ( n = 13), while only 1 tool measured barrier self-efficacy, and approximately half of the tools ( n = 7; 54%) reported on the validity and reliability. Great variability existed among the self-efficacy items included in the tools; however, common constructs included: teaching/leading physical activity, fundamental movement skill development, and physical activity programming. Very few tools mentioned sedentary behavior ( n = 2) and outdoor/risky play ( n = 2). Given the low number of studies that tested validity and reliability of their self-efficacy tools, the lack of consideration for barrier self-efficacy, and the paucity of tools that fully encompassed physical activity, sedentary behavior, and outdoor play considerations for ECEs, future research is needed to validate a new, reliable tool.

Self-assessment of physical development of student youth in the process of formation of individual physical culture

Relevance. In the physical education of students during the formation of individual physical culture is relevant to the issue of self-assessment of physical development, the study of motivation to engage in various types of physical activity among students. The purpose of the work is to study the self-assessment of physical development and motivation in physical education among student youth in the process of formation of individual physical culture. Methods: analysis and generalization of data of scientific and methodical literature and sources of the Internet; sociological methods; psychological and diagnostic methods; pedagogical methods; methods of statistical data processing. Experimental studies were conducted at Borys Grinchenko Kyiv University. The study involved students of 1-3 grades, 105 people (58 boys and 47 girls). Results. In the course of the research, priorities were established in the motives and interests of student youth during physical education classes. The level of physical conditions of students according to the results of motor tests is determined. The individual profile of the physical «I» of the individual is determined with the help of the test-questionnaire EM Bochenkova «Self-description of physical development», which is a modified version of the known method of A.M. Parishioners. It is established that at a low level of «self-esteem» students generally rate «coordination of movements», «endurance», «flexibility». With a low self-esteem of «sports abilities» and «physical activity», the studied students rate the «appearance» and consider themselves quite attractive. In general, the level of self-esteem on some scales increases with age («global physical self», «strength», «endurance»). In order to form an individual culture of students’ health, it is necessary for the participants of the educational space to master the standards of self-preserving behavior and the culture of a healthy lifestyle to increase healthy activity. It is shown that students with a high level of physical fitness have higher scores on all indicators of the scale and they have a higher overall level of self-esteem. At the same time, students with a low level of physical fitness have an inflated self-esteem in relation to "appearance".