Can Early Intervention Improve Maternal Well-Being? Evidence from a Randomized Controlled Trial.

OBJECTIVE: This study estimates the effect of a targeted early childhood intervention program on global and experienced measures of maternal well-being utilizing a randomized controlled trial design. The primary aim of the intervention is to improve children's school readiness skills by working directly with parents to improve their knowledge of child development and parenting behavior. One potential externality of the program is well-being benefits for parents given its direct focus on improving parental coping, self-efficacy, and problem solving skills, as well as generating an indirect effect on parental well-being by targeting child developmental problems. METHODS: Participants from a socio-economically disadvantaged community are randomly assigned during pregnancy to an intensive 5-year home visiting parenting program or a control group. We estimate and compare treatment effects on multiple measures of global and experienced well-being using permutation testing to account for small sample size and a stepdown procedure to account for multiple testing. RESULTS: The intervention has no impact on global well-being as measured by life satisfaction and parenting stress or experienced negative affect using episodic reports derived from the Day Reconstruction Method (DRM). Treatment effects are observed on measures of experienced positive affect derived from the DRM and a measure of mood yesterday. CONCLUSION: The limited treatment effects suggest that early intervention programs may produce some improvements in experienced positive well-being, but no effects on negative aspects of well-being. Different findings across measures may result as experienced measures of well-being avoid the cognitive biases that impinge upon global assessments.

Effects of early intervention on dietary intake and its mediating role on cognitive functioning: a randomised controlled trial.

OBJECTIVE: To investigate the impact of an early intervention programme, Preparing for Life, on dietary intake between 12 and 36 months of age, and the mediating role played by diet on cognitive functioning. DESIGN: A randomised controlled trial evaluation of a community-based home visiting programme. The intervention involved biweekly visits from mentors from pregnancy until age 5 years and parent training at age 2 years. Dietary intake was assessed at 12, 18, 24 and 36 months using an FFQ to calculate the proportion meeting dietary recommendations. Cognitive functioning was measured at 24 and 36 months. Treatment effects were estimated using conventional χ 2 tests, permutation testing, inverse probability weighting and the stepdown procedure. Mediation analysis examined the indirect effect of the intervention on cognitive functioning via its effect on dietary intake. SETTING: Socio-economically disadvantaged communities in Dublin, Republic of Ireland. SUBJECTS: Pregnant women (n 233) were assigned to the intervention (n 115) or control (n 118) group using an unconditional probability randomisation strategy. RESULTS: Positive treatment effects were observed for meeting dietary recommendations for protein foods at 24 (OR=2·52) and 36 (OR=2·42) months, and all food groups at 24 (OR=3·92) months. There were no effects on grain, dairy, fruit and vegetable, or fatty/sugary food recommendations in most models. The conventional and more novel methods yielded similar results. Mediation analysis indicated that 13 % of the intervention's effect on cognitive functioning was mediated by 36-month protein food consumption. CONCLUSIONS: The study demonstrates some potential to alter early childhood dietary patterns through community-based intervention programmes.

Early intervention and child physical health: Evidence from a Dublin-based randomized controlled trial.

This article investigates the impact of an early intervention program, which experimentally modifies the parenting and home environment of disadvantaged families, on child physical health in the first 3 years of life. We recruited and randomized 233 (115 intervention, 118 control) pregnant women from a socioeconomically disadvantaged community in Dublin, Ireland into an intervention or control group. The treatment includes regular home visits commencing antenatally and an additional parenting course commencing at 2 years. Maternal reports of child health are assessed at 6, 12, 18, 24, and 36 months. Treatment effects are estimated using permutation testing to account for small sample size, inverse probability weighting to account for differential attrition, and both the stepdown procedure and an indices approach to account for multiple hypothesis testing. Following adjustment for multiple testing and attrition, we observe a positive and statistically significant main treatment effect for wheezing/asthma. The intervention group are 15.5 percentage points (pp) less likely to require medical attention for wheezing/asthma compared to the control group. Subgroup analysis reveals more statistically significant adjusted treatment effects for boys than girls regarding fewer health problems (d=0.63), accidents (23.9pp), and chest infections (22.8-37.9pp). Our results suggest that a community-based home visiting program may have favorable impacts on early health conditions.

Myiasis of the ear: a review with entomological aspects for the otolaryngologist.

OBJECTIVE: Myiasis is the infestation of live humans (or animals) by fly larvae. Although the diagnosis is relatively straightforward, how to best treat aural myiasis has not been well described in the literature. This comprehensive literature review, therefore, was performed to identify current management principles in aural myiasis, especially with regard to the causative fly family. In addition, we explore the possible relationship between aural myiasis and the highly lethal intracranial myiasis. DATA SOURCES: Literature review using the Medline database (PubMed), Scopus, and Google Scholar. REVIEW METHODS: Manuscripts published in the English language between January 1, 1992, and December 31, 2012, were included. RESULTS: Forty-five cases of aural myiasis were reported in 34 manuscripts. Most cases were caused by species of the Sarcophagidae family (n=26/45, 57.8%). The majority of cases (n=40/45, 88.9%) were successfully treated with simple aural toilet and topical treatments alone. No deaths were reported and no cases were seen in conjunction with intracranial myiasis. CONCLUSION: Aural myiasis is a rare but benign fly infestation of the ear, most commonly by species of the Sarcophagidae family. The overwhelming majority of cases can be successfully managed without the need for surgical intervention.