342 research outputs found
Table_S1 – Supplemental material for Material and Relational Difficulties: The Impact of the Household Environment on the Emotional Well-Being of Young Black Women Living in Soweto, South Africa
No full textSupplemental material, Table_S1 for Material and Relational Difficulties: The Impact of the Household Environment on the Emotional Well-Being of Young Black Women Living in Soweto, South Africa by Emmanuel Cohen, Lisa J Ware, Alessandra Prioreschi, Catherine Draper, Edna Bosire, Stephen J Lye and Shane A Norris in Journal of Family Issues</p
Young women’s perceptions of life in urban South Africa:: Contextualising the preconception knowledge gap
No full textRaising awareness to support improved health and well-being of young women in sub-Saharan Africa is critical, particularly in the preconception period in order to achieve improved health for multiple generations. To inform messaging campaign on preconception health, we conducted eight focus group discussions (FGDs) with young women in Soweto to understand their perceptions and access to health messages. Preconception health was generally not a familiar topic for young women. Participants prioritised information seeking for other pressing challenges they faced such as poverty and unemployment. Within this context, mental health was viewed as important, while physical health only gained importance when illness was present or during pregnancy. Television, radio and community health workers were all viewed as useful communication channels for health messaging. Understanding the importance of preconception health of young adults to benefit from the triple dividend of better health now, better health for the future and for children is a critical knowledge gap for young women. Messages aimed to improve preconception physical and mental health could leverage significant health gains. Health messages should be contextualised within the experiences that young women face and should offer information to help young women cope with their challenges. (Afr J Reprod Health 2021; 25[2]: 39-49)
Contextualising individual, household and community level factors associated with sugar-sweetened beverage intake and screen time in Soweto, South Africa
No full textThis study examined the relationship between individual, household, and community-level factors with obesity-related health behaviors. Households (n = 6110) were enumerated, and participants (>18 years) reported their screen time and how many sugar-sweetened beverages they consumed per day. Individuals from food insecure and higher SES households were more likely to report higher sugar-sweetened beverage consumption. Screen time was negatively associated with age (p < .01), and being female was associated with 35 minutes more screen time per day (p < .01). Community and household factors were independent drivers of behavior that need to be incorporated into individual level interventions, or considered in analyses.</p
Development, implementation, and process evaluation of Bukhali: an intervention from preconception to early childhood
No full textThe Healthy Life Trajectories Initiative, an international consortium developed in partnership with the World Health Organization, is addressing childhood obesity from a life-course perspective. It hypothesises that an integrated complex intervention from preconception, through pregnancy, infancy and early childhood, will reduce childhood adiposity and non-communicable disease risk, and improve child development. As part of the Healthy Life Trajectories Initiative in South Africa, the Bukhali randomised controlled trial is being conducted with 18–28-year-old women in Soweto, where young women face numerous challenges to their physical and mental health. The aims of this paper were to describe the intervention development process (including adaptations), intervention components, and process evaluation; and to highlight key lessons learned. Intervention materials have been developed according to the life-course stages: preconception (Bukhali), pregnancy (Bukhali Baby), infancy (Bukhali Nana; birth—2 years), and early childhood (Bukhali Mntwana, 2–5 years). The intervention is delivered by community health workers, and includes the provision of health literacy resources, multi-micronutrient supplementation, in-person health screening, services and referral, nutrition risk support, SMS-reminders and telephonic contacts to assist with behaviour change goals. A key adaption is the incorporation of principles of trauma-information care, given the mental health challenges faced by participants. The Bukhali process evaluation is focussing on context, implementation and mechanisms of impact, using a mixed methods approach. Although the completion of the trial is still a number of years away, the documentation of the intervention development process and process evaluation of the trial can provide lessons for the development, implementation, and evaluation of such complex life-course trials
Gene-environment Interactions Underlying the Developmental Origins of Health and Disease
No full textRetrospective epidemiological studies of British cohorts have found an inverse relationship between birth size and rates of mortality from cardiovascular disease and stroke. Subsequently, further studies in humans and in animals have demonstrated that there is an inverse relationship with a combination of suboptimal prenatal and postnatal environments and the development of the metabolic syndrome (insulin resistance, hypertension, obesity and dyslipidemia). However, recently it has been reported that not all individuals exposed to these environments develop these conditions, suggesting that an individual’s genotype may contribute to the eventual outcome. Phylogenetically distinct, murine strains allow the genetic dissection of complex phenotypic traits; however, to date, they have not been utilized to evaluate the gene-environment interaction underlying these inverse relationships. Thus, A/J and C57BL/6J mice were subjected to prenatal undernutrition, to model an adverse intra-uterine environment, and although prenatal undernutrition resulted in fetal growth restriction of equal magnitude, remarkable strain differences were observed. At the end of gestation C57BL/6J mice showed significant alterations in fetal organ weights (liver, kidneys and placenta) and glucocorticoids (elevation). Postnatally, C57BL/6J offspring demonstrated catch-up growth, obesity, impaired glucose tolerance, insulin resistance, increased blood pressure, liver dysfunction and altered cardiovascular function compared to strain and gender matched controls. The A/J strain was resistant to the development of prenatal and postnatal pathologies, except they also demonstrated alterations in cardiovascular function. Females of both strains displayed a more moderate phenotype than the males. Although feeding undernutrition mice an atherogenic diet postnatally did not exacerbate the phenotype, postnatal dietary supplementation of omega-3 long chain unsaturated fatty acids completely reversed the undernutrition induced altered metabolic phenotype in C57BL/6J. Microarray analysis revealed that adult A/J and C57BL/6J mice have distinct gene expression profiles, under control dietary conditions, and that this differential strain expression profile changes in adult offspring in response to prenatal undernutrition. The expression profiles predicted onset of metabolic and liver diseases within the C57BL/6J strain, clearly linking the observed phenotype to alterations in gene expression. These expression differences were also linked to inherent strain differences in the genetic code where a disproportionate number of differential expressed genes had function altering polymorphisms.Ph
“You go an extra mile”: a qualitative study of community health worker perspectives in a health promotion intervention in urban South Africa
No full textAbstract Background As part of the Healthy Life Trajectories Initiative in South Africa, the Bukhali health promotion intervention is being implemented by community health workers (CHW’s) with young women in urban Soweto. The perspectives of these CHW’s have not been fully explored. Methods A qualitative study was conducted to describe CHW’s perspectives and experiences of delivering the Bukhali intervention. Three focus groups were conducted with the 13 CHWs employed at the time of the study, and a thematic approach was taken to data analysis. Results Themes identified included: contextual realities for participants and CHWs, building relationships with participants, workload, emotional toll, and learning and development. Since they are recruited from Soweto, CHWs experienced similar contextual challenges to participants, and have to manage multiple roles, including health promotion and education, referral and support within the health system, counselling (although out of their scope of work), and data recording. The findings indicate the critical role CHWs play in building relationships with participants, especially establishing trust. Many CHWs spoke about going beyond what was expected in their role, which sometimes involved taking participants to medical facilities, and sharing resources with their participants. They spoke about the emotional toll of managing these relationships, their workload, and particularly the need for resilience and boundaries. CHWs experienced learning and development in their role as positive. Conclusions These findings provide a voice for these CHWs, but they also offer important learning of the implementation of the Bukhali intervention within the context of Soweto, as well as, future potential scale-up of CHW-delivered interventions in South Africa and other low- and middle-income countries
Social vulnerability, parity and food insecurity in urban South African young women: the healthy life trajectories initiative (HeLTI) study
No full textSocial vulnerability indices (SVI) can predict communities’ vulnerability and resilience to public health threats such as drought, food insecurity or infectious diseases. Parity has yet to be investigated as an indicator of social vulnerability in young women. We adapted an SVI score, previously used by the US Centre for Disease Control (CDC), and calculated SVI for young urban South African women (n = 1584; median age 21.6, IQR 3.6 years). Social vulnerability was more frequently observed in women with children and increased as parity increased. Furthermore, young women classified as socially vulnerable were 2.84 times (95% CI 2.10–3.70; p < 0.001) more likely to report household food insecurity. We collected this information in 2018–2019, prior to the current global COVID-19 pandemic. With South Africa having declared a National State of Disaster in March 2020, early indicators suggest that this group of women have indeed been disproportionally affected, supporting the utility of such measures to inform disaster relief efforts.</p
Cross-sectional associations between mental health indicators and social vulnerability, with physical activity, sedentary behaviour and sleep in urban African young women
No full textBACKGROUND: Relationships between mental health and multiple health behaviours have not been explored in young South African women experiencing social constraints. The aim of this study was to identify associations between mental health indicators and risk factors with physical activity, sedentary behaviour, and sleep, amongst young women living in Soweto, a predominantly low-income, urban South African setting. METHODS: For this cross-sectional study, baseline measurements for participants (n = 1719, 18.0–25.9 years old) recruited for the Healthy Life Trajectories Initiative were used including: physical activity, sedentary behaviour (sitting, screen and television time), sleep (duration and quality), depression and anxiety indicators, emotional health, adverse childhood experiences, alcohol-use risk; social vulnerability, self-efficacy, and social support. RESULTS: Multiple regression analyses showed that depression (β = 0.161, p < 0.001), anxiety (β = 0.126, p = 0.001), adverse childhood experiences (β = 0.076, p = 0.014), and alcohol-use risk (β = 0.089, p = 0.002) were associated with poor quality sleep. Alcohol-use risk was associated with more screen time (β = 0.105, p < 0.001) and television time (β = 0.075, p < 0.016). Social vulnerability was associated with lower sitting time (β = − 0.187, p < 0001) and screen time (β = − 0.014, p < 0.001). Higher self-efficacy was associated with more moderate- to vigorous-intensity physical activity (β = 0.07, p = 0.036), better-quality sleep (β = − 0.069, p = 0.020) and less television time (β = − 0.079, p = 0.012). Having no family support was associated with more sitting time (β = 0.075, p = 0.022). Binomial logistic regression analyses supported these findings regarding sleep quality, with anxiety and depression risk doubling the risk of poor-quality sleep (OR = 2.425, p < 0.001, OR = 2.036, p = 0.003 respectively). CONCLUSIONS: These findings contribute to our understanding of how mental health indicators and risk factors can be barriers to health behaviours of young women in Soweto, and that self-efficacy and social support can be protective for certain of these behaviours for these women. Our results highlight the uniqueness of this setting regarding associations between mental health and behaviours associated with non-communicable diseases risk. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12966-022-01325-w
The Modulation of Androgen Signaling by Steroid Hormones and Mechanical Tension: A Novel Pathway of Labor Initiation
No full textWe investigated the gestational expression of androgen receptor (AR) and defined its
regulation and that of its co-repressors, PSF and p54nrb, by steroid hormones and
myometrial stretch in vivo in pregnant and non-pregnant rats. Our data demonstrate
that, 1) myometrial AR expression decreases prior to term; 2) AR expression is
up-regulated by MPA treatment and down-regulated by mechanical stretch; (3)
myometrial PSF protein expression is down-regulated by estrogen signaling and by
mechanical stretch, and up-regulated by androgen signaling; (4) while myometrial PSF
mRNA expression is also down-regulated by stretch, the regulation by estrogen and P4
on PSF mRNA appear to be opposite to the effects on PSF protein. We conclude that
the decreased androgen signaling in late pregnancy (as a result of decreased AR and
PSF expression mediated by hormonal and mechanical signals) may contribute to the
mechanisms leading to labor initiation.MAS
Matrix Metalloproteinase Expression and Regulation During Pregnancy, Term Labour, and Postpartum
No full textIt is widely accepted that pregnancy, spontaneous term labour (TL), and postpartum (PP) involution is associated with changes in the cellular and extracellular composition of the uterus. These changes involve metalloproteinases (MMPs) secretion by myometrial smooth muscle cells and infiltrating leukocytes. MMP activation results in collagenolysis, modulation of cellular behaviour and barrier function. I hypothesize that during late gestation, the expression and activity of myometrial MMPs and their tissue inhibitors (TIMPs) increase in preparation for TL, and are regulated by mechanical stretch. The current in vivo study demonstrated that gene and protein expression of MMP-7 and MMP-11 were upregulated during TL, suggesting labour promotion; whereas other MMPs (2, 3, 8, 9, 10, 12) were induced only during the early PP period. The sources of myometrial MMPs during TL and PP include myocytes and resident leukocytes. In vitro studies did not support the regulation of myometrial MMP expression by mechanical stretch.M.Sc
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