Cognitive and Motor Development in 3- to 6-Year-Old Children Born to Mothers with Hyperglycaemia First Detected in Pregnancy in an Urban African Population.

OBJECTIVES: Hyperglycaemia first detected in pregnancy (HFDP), on the rise in urban sub-Saharan Africa (SSA), may negatively impact foetal neurodevelopment, with potential long-term cognitive consequences for the child. Data on this association from SSA is lacking, and we aimed to investigate the association in 3- to 6-year-old children in Soweto, South Africa. METHODS: In this comparative study, we compared cognitive skills measured with the Herbst Early Childhood Development Criteria test in 95 children born to mothers with HFDP and 99 participants unexposed to maternal HFDP. Fine and gross motor skills were secondary outcomes. Ordinal regression analysis with known confounders was performed for children born at-term. RESULTS: Of children exposed to HFDP born at-term, 24.3% scored 'high' and 25.7% scored 'low' in the cognitive subsection of the test, as opposed to 37.7% and 12.9% in the HFDP-unexposed group, respectively. In ordinal regression, exposed participants had a significantly lower odds of scoring in a higher cognitive category when adjusting for maternal confounders and socio-economic status (OR 0.33, 95% CI 0.15-0.74, p = 0.007). No difference was found in gross motor development between the two groups; differences in fine motor development were attenuated after adjustment for maternal pregnancy factors and household socioeconomic status (OR 0.62, 95% CI 0.28-1.37, p = 0.239). CONCLUSIONS FOR PRACTICE: Exposure to HFDP was negatively associated with cognitive development at preschool age. Optimising maternal (preconception) health and early childhood cognitive stimulation could help more children reach their developmental potential.

Perceptions of healthy food, and perceived facilitators and barriers to buying and consuming healthy food, among female caregivers in Soweto, South Africa

Background. Obesity poses a continuous health challenge in South Africa and disproportionately affects black African households. To target obesity in these settings, it is crucial to have an in-depth understanding of food choices made by affected households. Objectives. To explore how healthy food is perceived by women living in Soweto, and the facilitators of and barriers to buying and consuming this food. Methods. This was a qualitative study that utilized semi-structured interviews. Ten participants were recruited using purposive sampling. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analysis. The study took place in Soweto, South Africa, and was conducted from February to May 2019. Results. Six themes were developed from the data: perceptions of healthy food; protecting family members from unhealthy food; learning about healthy food; appreciation by the family; home-cooked food v. food bought on the street; and budgetary restrictions. The first three themes were grouped by the overarching theme 'consciousness of healthfulness of food', and the last three themes were grouped by the theme 'influences of the family and environment on food choice'. Conclusions. A focus on the whole family's dietary behaviours is recommended and, in future interventions, guidance communicated in intervention materials should be tailored to existing knowledge of healthy eating.

24 hour movement behaviours and the health and development of pre-school children from Zimbabwean settings: the SUNRISE pilot study.

Background: In 2019, the World Health Organization (WHO) released global guidelines for physical activity, sedentary behaviour and sleep for the early years. The International Study of Movement Behaviours in the Early Years, SUNRISE, aimed to assess the extent to which children aged three and four years meet the WHO global guidelines and its association with health and development. Objectives: To assess movement behaviours in pre-school children from low-income settings in Zimbabwe and to establish associations between these movement behaviours and adiposity, motor skills and executive function. Methods: Pre-school children/caregivers were recruited from two urban and two rural public schools respectively in Zimbabwe. The caregivers answered questions on the children's physical activity, screen time, sedentary behaviour and sleep patterns. Children's movement behaviours were objectively measured using accelerometers. Gross and fine motor skills and executive function were assessed using the Ages and Stages Questionnaire-3 and Early Years Toolbox, respectively. Focus group discussions were carried out with caregivers and teachers on the acceptability and feasibility of the study. Results: Eighty-one children participated in the study. The proportions of children meeting the guidelines were physical activity 92%, sedentary behaviour 70%, and sleep 86%, and all guidelines combined 24%. Boys and girls were similar (p>0.05 for all variables) for all executive function variables, but rural children had significantly lower inhibition scores (p=0.026) than urban children. Conclusion: The study adds to the growing literature on movement behaviours and associated risk factors in low-resourced settings. Further investigations of movement behaviours in this age group in Zimbabwe are recommended.

Pilot implementation of Bukhali: A preconception health trial in South Africa.

OBJECTIVES: This article describes the learnings from the pilot phase of the Healthy Life Trajectories Initiative, a preconception health trial for 18- to 25-year-old women in Soweto, South Africa. METHODS: The study compares two arms focussed on either physical and mental health (intervention; delivered by community health workers - 'Health Helpers') or standard of care plus (control; standard access to healthcare plus additional telephonic input on 'life skills'; delivered by call centre assistants). These are collectively referred to as Bukhali. Data on the pilot implementation of the Bukhali trial (n = 1655) were collected from (1) weekly team meetings, (2) two focus groups (one with the intervention team Health Helpers, n = 7; one with intervention participants, n = 8) and one paired interview with control call centre assistants (n = 2), (3) notes from eight debrief sessions with Health Helpers and (4) quantitative trial monitoring data. Qualitative data were thematically analysed. RESULTS: The findings clustered within three themes: (1) challenges for young women in Soweto, (2) priorities for young women in Soweto and (3) implementation challenges and perceptions of the intervention. Challenges were mostly related to tough socioeconomic circumstances and less prioritisation of living a healthier life. The priorities of employment and educational opportunities reflected the socioeconomic challenges, where health was not recognised as priority. The main challenge to participation and compliance with the trial was that young women in Soweto generally wanted a tangible and preferably financial and immediate benefit. Community peer sessions, despite being recommended by young women as part of the intervention development, were not successful. Many women also moved between multiple households within Soweto, which flagged concerns for a cluster trial and risk of contamination. CONCLUSION: Preconception health trials should consider socioeconomic challenges present in urban poor contexts. Learnings from the pilot phase significantly affected the design and implementation of the main Bukhali trial.

Understanding the influence of 24-hour movement behaviours on the health and development of preschool children from low-income South African settings: the SUNRISE pilot study.

Background: The International Study of Movement Behaviours in the Early Years, SUNRISE, was initiated to assess the extent to which young children meet movement behaviour guidelines (physical activity, sedentary behaviour, screen time, sleep). Objective: The South African SUNRISE pilot study assessed movement behaviours in preschool children from two low-income settings, and associations between these movement behaviours, adiposity, motor skills and executive function (EF). Methods: Preschool child/parent pairs (n = 89) were recruited from preschools in urban Soweto and rural Sweetwaters. Height and weight were measured to assess adiposity. Physical activity was assessed using accelerometers while sedentary behaviour, screen time and sleep were assessed via parent report. Fine and gross motor development were measured using the Ages and Stages Questionnaire-3, and EF was assessed using the Early Years Toolbox. Results: The proportion of children meeting the physical activity guideline was 84%, 66% met the sleep guideline, 48% met the screen time guideline, and 26% met all three guidelines. Rural children were more active, but spent more time on screens compared to urban children. Most children were on track for gross (96%) and fine motor (73%) development, and mean EF scores were in the expected range for all EF measures. EF was negatively associated with screen time, and gross motor skills were positively associated with physical activity. Conclusion: The South African SUNRISE study contributes to the growing literature on 24-hour movement behaviours in SA preschool children, and highlights that these behaviours require attention in this age group.

Urban young women's preferences for intervention strategies to promote physical and mental health preconception: A Healthy Life Trajectories Initiative (HeLTI).

This study aimed to qualitatively investigate young women's preferences for preconception intervention strategies to promote physical and mental health in a rapidly transitioning, urban setting. Four semi-structured focus group discussions were conducted with young women (n = 29, 18-24 years old) from Soweto, South Africa. Qualitative data were thematically analysed. Two main themes were identified: 1) challenges and needs of intervention beneficiaries; and 2) preferences for intervention strategies (content and delivery). The challenges participants mentioned could be classified as those relating to social pressure, identity, and socioeconomic circumstances. Mental health support appeared to be a greater need than physical health, and this featured in their preferences for intervention content, although a number of physical health topics were also mentioned (healthy eating and contraception). Participants had mixed preferences for intervention materials, ranging from printed to electronic and mobile resources. Their preferences for intervention activities ranged from educational sessions, to fun and interactive practical activities, and activities they could take home. Community health workers (CHWs) were the preferred agent of delivery for interventions, though participants emphasised the importance of CHWs having appropriate interpersonal skills and own life experience. Some women preferred one-on-one sessions with a CHW, while others preferred group sessions. While recognising the value of family sessions, young women were less enthusiastic about this approach. These findings provide valuable formative data for developing effective interventions to optimise young women's preconception health in urban Africa. These contextual realities should be acknowledged when addressing key physical and mental health issues facing young women.

Gross motor skills of South African preschool-aged children across different income settings.

OBJECTIVES: No studies have investigated gross motor skill (GMS) proficiency of preschool-aged children across different income settings in South Africa. Research from high-income countries suggests that children from low-income settings display poorer GMS proficiency compared to higher-income peers. This study aimed to (1) describe GMS proficiency of preschool-aged children in urban high-income (UH), urban low-income (UL) and rural low-income (RL) settings; and (2) explore differences in proficiency between income settings and sex. DESIGN: Descriptive cross-sectional study. METHODS: The Test of Gross Motor Development-Edition 2 (TGMD-2) was used to assess GMS. The TGMD-2 gross motor quotient, standardised scores and raw scores were used to describe proficiency. RESULTS: GMS proficiency was assessed in n=259 3-6-year-old children (n=46 UH, n=91 UL, n=122 RL). Overall, 93% of the children were classified as having 'average' or better GMS. According to TGMD-2 standardised scores, the RL children performed significantly better than UH and UL children (p=0.028 and p=0.009, respectively). RL children were significantly more proficient than UH and UL children in the strike and horizontal jump when comparing raw scores. Overall, boys performed significantly better than girls in the strike, stationary dribble, kick and leap when comparing raw scores (all p<0.001). CONCLUSIONS: This study reports high GMS proficiency in preschool-aged children across income settings in South Africa. The factors associated with higher GMS in low-income settings are not immediately obvious. Thus, future research should explore potential factors and identify opportunities to ensure that GMS proficiency is capitalised on as preschool-aged children enter formal schooling.

Results from the healthy active kids South Africa 2018 report card

Background. Healthy Active Kids South Africa (HAKSA) Report Cards were produced in 2007, 2010, 2014 and 2016. Objective. The 2018 Report Card aims to report on the latest available evidence relating to the physical activity (PA), nutrition and body composition of South African (SA) children and adolescents. Methods. A review was conducted using the following databases: PubMed; Africa Journals Online; and Africa-Wide (EBSCOhost). Articles published from January 2016 to September 2018 were included for review by the HAKSA scientific advisory group. Data were extracted, and a grade for each indicator was assigned based on the available evidence and the consensus of the scientific advisory group. This included 12 PA indicators, 6 nutrition indicators and 3 body composition indicators. Results. There was no evidence of a significant change in any of the indicators since the 2016 Report Card. Grades for certain indicators have been downgraded (from 2016) to bring these to the attention of relevant stakeholders and industry. These include food insecurity and grades that relate to the implementation of policy on PA and nutrition in the school environment, and on advertising and media relating to nutrition. Conclusion. Key priorities for action include: safe opportunities for physical activity; minimising the gap between policy and implementation (school culture and environment, and government strategies); and the double burden of over- and undernutrition, which relates to the continuing concern about food insecurity in SA. There is a need for further research, including surveillance, on all indicators, for future Report Cards

Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children.

Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy.

Impact of social norms and social support on diet, physical activity and sedentary behaviour of adolescents: a scoping review.

The prevalence of non-communicable diseases (NCDs) in adulthood is rapidly increasing, and it is essential that risk factors for NCDs be addressed in adolescence, both for the health of individuals during adolescence and for their health in later life. These risk factors include diet, physical activity and sedentary behaviour. No literature has been published that comprehensively summarizes the impact of social norms and social support on these behaviours among adolescents. Therefore, a scoping review was conducted to determine the extent of recent (since 2000) literature available on this topic. A comprehensive search strategy was used to search PubMed and EMBASE for eligible reviews. Review papers (narrative reviews, systematic and non-systematic reviews) published in English in peer-reviewed journals from 2000 to February 2013 were included in the overview. Two of the authors screened the titles and abstracts of the search results independently. Thirty reviews were included in the scoping review. This scoping review has shown sufficient evidence for parental influences, and especially the positive impact of an authoritative parenting style, on healthy behaviours of adolescents, although the evidence is somewhat more compelling for diet than for physical activity and sedentary behaviour. More research is needed to investigate parental and family influences on physical activity and sedentary behaviour. And the effect of peer influences on diet, physical activity and sedentary behaviour of adolescents requires further investigation. The evidence presented affirms the consideration of social norms and social support in the development of interventions to address these behaviours in adolescents. The evidence regarding parenting style provides some concrete guidance for such interventions.

Competence for internship: perceptions of final-year medical students.

CONTEXT: A 'new', problem-based medical curriculum was introduced at the University of Cape Town (UCT) in 2002. The objective of this study was to assess the perceptions of competence for internship and the factors influencing competence of final-year medical students. METHODS: Eighteen focus groups were conducted (six per year) with UCT final-year medical students in 2007 (n =27), 2008 (n =27), and 2009 (n =30). Guide questions covered student's expectations of internship, perceptions of competence, priorities regarding competence, and factors influencing competence. RESULTS: Participants felt generally positive about and competent to enter internship, and the transition into internship was characterized as having both personal and professional components. Participants identified interpersonal skills, theoretical grounding, and intellectual ability as strengths, and lack of basic science knowledge and certain procedural skills as weaknesses. Factors influencing competence included personal initiative, motivation, and clinical exposure. Curriculum strengths identified were teaching of interpersonal skills and development of students as lifelong learners. The main weaknesses identified were teaching and assessment of basic sciences, and problem-based learning (PBL). Overall, the participants felt generally positive about internship and the 'new' curriculum, and felt generally competent to enter internship. Their responses highlight the role of confidence in the development of competence. CONCLUSIONS: These findings highlight the complexities surrounding perceptions of students about competence and views about the content and methodology of the learning. Perceptions of students regarding competence are an important indicator of the attainment of intended curriculum outcomes, and provide valuable information for the improvement of curriculum.

Comparison of types and antimicrobial susceptibility of Staphylococcus from conventional and organic dairies in west-central Minnesota, USA.

AIMS: To assess whether conventional and organic dairy management practices are associated with differences in the susceptibility of Staphylococcus to antimicrobial agents. METHODS AND RESULTS: Staphylococcus was isolated from milk samples collected from conventional and organic dairies in west-central Minnesota. Isolates were categorized as (1) coagulase-positive, (2) novobiocin-sensitive coagulase-negative or (3) novobiocin-resistant coagulase-negative. Novobiocin-resistant coagulase-negative Staphylococcus (CNS) was more common on conventional farms and novobiocin-sensitive CNS predominated the isolates from organic farms. Overall, a larger proportion of isolates from organic rather than conventional farms were susceptible to erythromycin, pirlimycin and tetracycline. However, for pirlimycin and tetracycline, different patterns of susceptibility were observed among Staphylococcus categories. CONCLUSION: In this study, organic dairy management was associated with more overall antimicrobial susceptibility among Staphylococcus than was conventional management. However, different patterns of susceptibility among Staphylococcus categories suggest that multiple management practices, including some unrelated to antimicrobial use, may contribute to the observed differences in susceptibility. SIGNIFICANCE AND IMPACT OF THE STUDY: This study adds to our understanding of the implications of dairy management choices.

Is cartilage thickness different in young subjects with and without patellofemoral pain?

OBJECTIVE: To determine the differences in load-bearing patellofemoral joint cartilage thickness between genders. To determine the differences in load-bearing cartilage thickness between pain-free controls and individuals with patellofemoral pain. METHODS: The articular cartilage thickness of the patella and anterior femur was estimated from magnetic resonance images in 16 young, pain-free control subjects (eight males, eight females) and 34 young individuals with patellofemoral pain (12 males, 22 females). The average age of all subjects was 28+/-4 years. The cartilage surfaces were divided into regions approximating the location of patellofemoral joint contact during knee flexion. The mean and peak cartilage thicknesses of each region were computed and compared using a repeated-measures Analysis of Variance. RESULTS: On average, males had 22% and 23% thicker cartilage than females in the patella (P < 0.01) and femur (P < 0.05), respectively. Male control subjects had 18% greater peak patellar cartilage thickness than males with patellofemoral pain (P < 0.05); however, we did not detect differences in patellar cartilage thickness between female control subjects and females with patellofemoral pain (P = 0.45). We detected no significant differences in femoral cartilage thickness between the control and pain groups. CONCLUSIONS: Thin cartilage at the patella may be one mechanism of patellofemoral pain in male subjects, but is unlikely to be a dominant factor in the development of pain in the female population.

Evidence to suggest morphological and physiological alterations of lacrimal gland acini with ageing.

This study investigates changes in the morphology and physiology of lacrimal gland acinar cells with age. Changes in microstructural appearance of the acinar cells, the type and distribution of the different acini in glands and the secretory granules within the acini were examined in glands from animals of 3-5, 9, 12, 20, 24 and 28 month old rats. Differences in the secretory capacity of the acinar cells were also examined in animals of each age-group, with the exception of 28 months. The typical acini of young glands (3-5 months) were of the serous type. This was also true of 9 month glands, although there was a significant reduction in their overall distribution compared to young glands. The acini in the 12 month glands were predominantly of the seromucous type and appeared to be at the expense of the serous acini which were further significantly reduced compared to 3-5 and 9 month glands. This remained the prevalent acini type in 20 month glands, however by 24 months there was a significant increase in the occurrence of mucous acini and this time appeared to be at the expense of the seromucous acini which were significantly reduced in glands of this age-group. The predominant acinar cell in 28 month glands, like 24 month glands, was of the mucous variety. Qualitative EM studies revealed a progressive change in the secretory products of the lacrimal gland acini, strongly correlating to changes in acinar cell type. Typical acini of both 3-5 and 9 month glands contained numerous protein secretory granules. The seromucous acini also of these age groups contained both protein and mucous secretory granules, with the protein secretory granules in higher abundance. By 12 months the typical seromucous acini was packed with both protein and mucous secretory granules of equal proportions. However, by 20 months the predominant seromucous acini contained fewer protein secretory granules and elevated occurrence of mucous secretory granules. By 24 and 28 months the acini contained even fewer protein secretory granules and the typical acinar cell was of the mucous type containing exclusively mucous secretory granules. The secretory capacity of the acini was also altered with age. Maximum protein output in response to cholinergic stimulation resulted in an initial significant increase with ageing from 3-5 months to 9 and 12 months followed by a later significant age-dependent reduction in output. However, maximal peroxidase release from acinar cells of 3-5 and 9 month glands was the same. This was followed by a significant age-dependent reduction in peroxidase release. Furthermore, the concentrations required to evoke these responses differed with age. These results present evidence to suggest that acinar cells of the lacrimal gland undergo progressive alterations with age. The type of acini changing initially from serous to seromucous acini (intermediate phase) followed by a gradual transformation of the seromucous acini to mucous acini. This in turn changes the properties of the acini from protein producing and secreting acini to mucous producing and secreting acini. The results also suggest a reduction in the ability of the acini to synthesise proteins with age and altered responsiveness to cholinergic stimulation to secrete proteins. These findings may help in explaining the occurrence of altered protein/tear secretion with ageing.

Age-related changes in morphology and secretory responses of male rat lacrimal gland.

This study investigates the differences in the outward appearance and morphology of lacrimal glands, the morphology within the lacrimal acinar cells and the secretion of protein from acinar cells of young (3-5 months) and aged (20 and 24 months) male rats. The appearance of the glands, as seen by the naked eye, differed between the three age-groups. The lacrimal gland of young animals was a smooth pink tissue, while the tissue from aged animals appeared lobular and white in colour, thought to result from infiltration of fatty/connective tissue. Glands from 24 month old animals had a more pronounced lobular appearance than the glands from 20 month old animals. Light microscopy studies revealed that as the animals aged there was evidence of progressive morphological changes. These changes included thickening of the connective tissue sheath, chronic inflammation with increased infiltration by mast cells, patchy destruction of ductal and vascular tissues, enlargement of lacrimal ducts, luminal swelling of the acini, and changes in acinar type. Electron microscopy (EM) studies revealed the presence of 3 types of acini in the rat lacrimal gland: acini which contained only protein secretory granules (serous acini), acini which contained protein and mucous secretory granules (seromucous acini), and acini which contained only mucous secretory granules (mucous acini). In young glands the majority of acini were serous with a few seromucous acini and even fewer mucous acini. In aged glands there were significant reductions in serous acini (ANOVA; P < 0.01) when compared to the young glands. In 20-month-old glands, there were marked increases in the percentage occurrence of seromucous acini, while in 24 month old glands, there were large increases in the relative number of mucous acini. Qualitative EM studies demonstrated that the typical acini from young glands contained numerous protein secretory granules. Ageing was associated with a progressive loss of protein (serous) secretory granules. Furthermore, marked changes and patchy destruction of the endoplasmic reticulum and Golgi apparatus were observed in acini of glands from aged rats when compared to acini of glands from young rats. Measurement of total protein output from acini revealed a significant (Student's t-test, P < 0.05) decrease in protein secretion from aged glands compared to glands from young animals. These results suggest that not only is there considerable structural damage, chronic inflammation and mast cell infiltration to the lacrimal gland with ageing, but also possible redifferentiation of acini from serous to seromucous and then to mucous acini. Furthermore, the results also suggest a reduction or an inability of the acini to synthesise and to secrete protein from glands of aged animals compared to glands of young rats. All of these changes appear to occur more rapidly as the rats mature between 20 and 24 months. These findings provide a morphological basis to explain the phenomenon of reduced tear/protein secretion with ageing.