Large-scale Intervention Program Research Articles

School-to-work transition: putting non-cognitive skills in context. The case of NEET and suggestions for policy

AbstractNEETs represent a category at risk for social exclusion and may show poor non-cognitive skills. In this review we target this issue, taking the contemporary theory of skills formation as a theoretical framework. Intrapersonal agency and motivational components, including educational aspirations, goal attainability, and investing in active efforts are protective factors for a successful school-to-work transition. Having an internal locus of control may help teenagers but might not compensate for a low socioeconomic status. Experiencing high-quality apprenticeships and internships could help teenagers find their vocational specificity. Large-scale intervention programs, promoting investment in human agency and motivation constitute a proper policy strategy.

Immune responses to malaria pre-erythrocytic stages: Implications for vaccine development.

Radiation-attenuated sporozoites induce sterilizing immunity and remain the ‘gold standard’ for malaria vaccine development. Despite practical challenges in translating these whole sporozoite vaccines to large-scale intervention programmes, they have provided an excellent platform to dissect the immune responses to malaria pre-erythrocytic (PE) stages, comprising both sporozoites and exoerythrocytic forms. Investigations in rodent models have provided insights that led to the clinical translation of various vaccine candidates—including RTS,S/AS01, the most advanced candidate currently in a trial implementation programme in three African countries. With advances in immunology, transcriptomics and proteomics, and application of lessons from past failures, an effective, long-lasting and wide-scale malaria PE vaccine remains feasible. This review underscores the progress in PE vaccine development, focusing on our understanding of host-parasite immunological crosstalk in the tissue environments of the skin and the liver. We highlight possible gaps in the current knowledge of PE immunity that can impact future malaria vaccine development efforts.

The Science and Ethics of Intervention Programmes in Family and Child Welfare: Towards Building an Inclusive Psychology for Social Justice

India’s cultural diversity is an illustration of sustainable engagement of people with their environment where cultural practices are in a delicate ecological balance often with meagre resources and harsh conditions. This balance is underestimated when programmes and services seek inspiration and guidance from global trends without adequate attention to local reality. Poverty is treated as a failure of the people (and by the people as a failure of the Government) rather than a consequence of long-standing structural marginalization. Blaming the victim has been an important theme in evaluating cultural practices of people living with disadvantage. This is a serious error in judgement both on scientific and ethical grounds. Despite enduring scholarly work that recognizes the need for context-sensitive theory and research in the field of psychology, institutional practices have remained largely loyal to global trends. Large-scale intervention programmes in community welfare persist with practices that derive directly from mainstream psychology, especially in the fields of education, family studies and child development. Through the financial and ideological push from international NGOs that prescribe objectives and strategies for intervention, the real problem remains ignored despite claiming impressive outreach. Primarily because of misplaced emphases and misconstrued priorities, intervention initiatives often fail to meet the objectives of social justice and equity. Furthermore, they may even result in distancing people in marginalized communities further, on account of unintended consequences of welfare activity. This can be seen in the large number of youth that hang precariously in between the world that they knew and the one that was implicitly promised to them. In spite of claims about coverage in terms of numbers, providing ecologically valid, cultural relevant and socially just services is restricted to a handful of committed agencies. This article will focus on specific instances of educational and welfare programmes that are advanced without either the knowledge about or respect for local community ideology in the desire to bring about social change for their “upliftment”. A special case in point is the persistent inability for the poor to access and participate in good quality education despite their enthusiasm and motivation. After providing an overview of the ideological mismatch between local culture and global policy, I will also give examples of experiments that have been successful in working towards ethically and scientifically sound welfare initiatives.

A maximum likelihood approach to power calculations for stepped wedge designs of binary outcomes.

In stepped wedge designs (SWD), clusters are randomized to the time period during which new patients will receive the intervention under study in a sequential rollout over time. By the study's end, patients at all clusters receive the intervention, eliminating ethical concerns related to withholding potentially efficacious treatments. This is a practical option in many large-scale public health implementation settings. Little statistical theory for these designs exists for binary outcomes. To address this, we utilized a maximum likelihood approach and developed numerical methods to determine the asymptotic power of the SWD for binary outcomes. We studied how the power of a SWD for detecting risk differences varies as a function of the number of clusters, cluster size, the baseline risk, the intervention effect, the intra-cluster correlation coefficient, and the time effect. We studied the robustness of power to the assumed form of the distribution of the cluster random effects, as well as how power is affected by variable cluster size. % SWD power is sensitive to neither, in contrast to the parallel cluster randomized design which is highly sensitive to variable cluster size. We also found that the approximate weighted least square approach of Hussey and Hughes (2007, Design and analysis of stepped wedge cluster randomized trials. Contemporary Clinical Trials 28, 182-191) for binary outcomes under-estimates the power in some regions of the parameter spaces, and over-estimates it in others. The new method was applied to the design of a large-scale intervention program on post-partum intra-uterine device insertion services for preventing unintended pregnancy in the first 1.5 years following childbirth in Tanzania, where it was found that the previously available method under-estimated the power.

Extensive genetic diversity among populations of the malaria mosquito Anopheles moucheti revealed by population genomics

Malaria vectors are exposed to intense selective pressures due to large-scale intervention programs that are underway in most African countries. One of the current priorities is therefore to clearly assess the adaptive potential of Anopheline populations, which is critical to understand and anticipate the response mosquitoes can elicit against such adaptive challenges. The development of genomic resources that will empower robust examinations of evolutionary changes in all vectors including currently understudied species is an inevitable step toward this goal. Here we constructed double-digest Restriction Associated DNA (ddRAD) libraries and generated 6461 Single Nucleotide Polymorphisms (SNPs) that we used to explore the population structure and demographic history of wild-caught Anopheles moucheti from Cameroon. The genome-wide distribution of allelic frequencies among samples best fitted that of an old population at equilibrium, characterized by a weak genetic structure and extensive genetic diversity, presumably due to a large long term effective population size. Estimates of FST and Linkage Disequilibrium (LD) across SNPs reveal a very low genetic differentiation throughout the genome and the absence of segregating LD blocks among populations, suggesting an overall lack of local adaptation. Our study provides the first investigation of the genetic structure and diversity in An. moucheti at the genomic scale. We conclude that, despite a weak genetic structure, this species has the potential to challenge current vector control measures and other rapid anthropogenic and environmental changes thanks to its great genetic diversity.

Consultants’ versus Managers’ - Perceptions of a Group Development Intervention Program

The present study examines a large scale intervention program within the manufacturing industry with the purpose of improving cooperation and health among both management and production teams. Altogether 31 management teams and 132 production teams, comprising 1596 individuals, participated in this intervention program. All the management teams were assigned a budget of nine hours of consultation-time each, plus a GDQ-measurement before and at the termination of the project. There were six meetings during the project and each meeting lasted one and a half hours. Four groups met concurrently, in the same room together with the two consultants. The present results target the issue of consultants’ and managers’ perceptions of the intervention process, but not the outcomes or the result of the intervention performed. Interviews were carried out with the two consultants who conducted the whole intervention and ten of the top managers who participated in the intervention. The interviews focused upon critical aspects associated with either success or failure before, during and after the intervention program. Content analyses were performed for consultant and managers separately, in order to extract themes describing their views of the intervention process. Similarities and differences between consultants’ and managers’ perceptions of the process are discussed.

Autonomous Motivation and Pro-Environmental Behaviours Among Bedouin Students in Israel: A Self-Determination Theory Perspective

AbstractPromoting pro-environmental behaviours (PEBs) among students is a major concern for educators. The present article presents an educational program based on a self-determination theory framework (SDT; Deci & Ryan, 2000) and a study demonstrating that working according to the theoretical principles presented in the program leads to the desired outcomes. The primary aim of the study was to test whether a hypothesised model in which autonomy support by students’ parents and moderators in a large-scale intervention program would be associated with autonomous motivation, which would in turn lead to PEBs, over and above the contributions of the students’ self-perceived competence and relatedness. The participants were 102 Bedouin high-school students (Grades 8 to 10) sampled from a cultural background characterised by a collectivist-hierarchical society in Israel. The results, based on structural equation modelling, indicated that moderators and parental autonomy support, as well as self-perceived relatedness and competence, were associated with students’ autonomous motivation, which in turn was associated with pro-environmental behaviours (including cleaning behaviours, activism, and preserving behaviours). The study supported the hypothesised model and demonstrated that SDT can be utilised as a theoretical framework for educational programs aimed at improving students’ self-determined PEBs.

Mineral content and in vitro iron bioavailability in seaweeds (1042.7)

Iron (Fe) deficiency remains a public health problem despite large‐scale intervention programs. Deficiency is often due to low iron intake and/or bioavailability, especially in plant‐based diets. With the Dietary Guidelines recommending a shift toward plant‐based diets, there is increased need to identify plant foods that are good sources of iron. Seaweeds are known to be rich in iron, but its bioavailability is poorly understood. Our objective was to evaluate the quality of seaweeds as an iron source by comparing their iron content and bioavailability to spinach. Seaweeds were obtained from commercial sources. Mineral assay by ICP‐ES showed that 10 of 13 seaweeds analyzed contained more Fe/g dry matter (DM) than spinach. Iron content in the seaweeds ranged from 73 to 3490 ug/g DM compared to 166 ug/g DM in spinach. Because of the high Fe content, most seaweeds could be considered good sources of iron based on a 10 g DM serving, e.g. 100% of the Daily Value of iron could be obtained from just 5.2 g of dulse powder, 2.3 g of dried sea lettuce, or 6 g of dried nori (one sheet). However, despite their high Fe content, bioavailability studies using the in vitro digestion/Caco‐2 cell model indicated that many seaweeds do not provide more bioavailable Fe per g DM than spinach. This was due to low Fe absorption efficiencies in the seaweeds. Exceptions were nori and sea lettuce which provided 3 and 5‐fold more bioavailable Fe per g DM than spinach, respectively. The higher bioavailability resulted from a combination of higher absorption efficiencies and higher Fe contents than spinach. In addition, vitamin C increased Fe bioavailability in these two seaweeds by over 100%. Some seaweed samples were found to contain high levels of aluminum (2 mg/g DM), arsenic (66 ug/g DM), or manganese (500 ug/g DM). The level of these contaminants should be considered when recommending seaweeds for regular consumption. We conclude that certain seaweeds could be good sources of iron provided that levels of potentially toxic minerals are low.Grant Funding Source: Supported by USDA/Hatch HAW000279‐H

Responding to medical crises: AIDS treatment, responsibilisation and the logic of choice

The framing of HIV/AIDS as a crisis has facilitated the rollout of large-scale intervention programmes that represent an enormous effort at mainstreaming biomedical rationalities and neoliberal notions of responsibilisation and self-care. Based on a ‘logic of choice’ (Mol 2008) and ‘responsibilised citizenship’ (Robins 2005a), although veiled in a language of rights and partnership, the heavy focus on individual behaviour and a pharmaceutical ‘solution’ to AIDS shifts the burden of responsibility for the success of the heavily funded programmes onto the shoulders of the patients and conceals alternative forms of responsibility. Analysing how HIV-positive people in Tanzania navigate life with HIV and the complex treatment regimens, this paper looks beyond biomedical rationality, which places the preservation of individual biological life at the centre of its logic, and analyses people's constant struggle to negotiate the meaning of ‘responsible behaviour’ in the context of their lived realities. This repositions the notion of responsibility in the realm of the social and reveals the rationality behind apparently irrational practices.

Paradigm lost: how parasite control may alter pattern and process in human helminthiases

Knowledge of pattern and process in helminth population biology is mostly based on the endemic equilibrium state that characterises infections before control. Current large-scale intervention programmes aim at controlling/eliminating helminth infection, transmission and morbidity. As a result, age-infection profiles will be modified; immune responses will be affected; underlying parasite distributions may become more aggregated; density-dependent regulatory processes will relax; and the contribution to transmission and morbidity of different host population groups will shift. There is an urgent need to understand how the paradigm that has guided parasite population biology research is changing under chemotherapy-based control programmes for this research to continue supporting parasite control efforts effectively.

Large-scale programs and medical literacy: beliefs about AIDS in Ghana

In this article we study knowledge about HIV/AIDS in Ghana. We investigate inhabitants' medical literacy, focusing on potential misconceptions of transmission mechanisms of the epidemic. Our basic premise is that well-organized health programmes over a longer time span will better prepare and fine-tune the local mentality for scientifically founded messages. We argue that the large-scale Navrongo Project and similar activities in the upper regions of Ghana are likely to have laid the groundwork for a receptive population, when it comes to understanding and believing in science-based information. Especially, we hypothesize that people living in the Upper East Region where the Navrongo Project has been located, to be more scientifically literate and have beliefs consistent with the medical paradigm for virus transmission. The main data source for statistical analyses is the Ghana Demographic and Health Survey from 2003, with a sample size of over 10,000 respondents of both sexes, aged 15-49 years. To evaluate individual and regional differences in such AIDS beliefs, we apply step-wise multiple regression analysis. This approach allows for investigating individual influences and structural effects together, tracing regional variations, as specific control variables are added to the exploratory framework. The findings suggest that large-scale intervention programmes for improving health standards in an African context can have important long-term effects on inhabitants' beliefs, beyond original aims. Notably, the massive Navrongo projects and related activities especially in the Upper East Region of Ghana, seemingly have increased inhabitants' trust in the medical model as compared to alternative paradigms. The empirical pattern is at least consistent with our main theoretical arguments, although further research is needed for a stronger test.

Geographic and ecologic heterogeneity in elimination thresholds for the major vector-borne helminthic disease, lymphatic filariasis

BackgroundLarge-scale intervention programmes to control or eliminate several infectious diseases are currently underway worldwide. However, a major unresolved question remains: what are reasonable stopping points for these programmes? Recent theoretical work has highlighted how the ecological complexity and heterogeneity inherent in the transmission dynamics of macroparasites can result in elimination thresholds that vary between local communities. Here, we examine the empirical evidence for this hypothesis and its implications for the global elimination of the major macroparasitic disease, lymphatic filariasis, by applying a novel Bayesian computer simulation procedure to fit a dynamic model of the transmission of this parasitic disease to field data from nine villages with different ecological and geographical characteristics. Baseline lymphatic filariasis microfilarial age-prevalence data from three geographically distinct endemic regions, across which the major vector populations implicated in parasite transmission also differed, were used to fit and calibrate the relevant vector-specific filariasis transmission models. Ensembles of parasite elimination thresholds, generated using the Bayesian fitting procedure, were then examined in order to evaluate site-specific heterogeneity in the values of these thresholds and investigate the ecological factors that may underlie such variabilityResultsWe show that parameters of density-dependent functions relating to immunity, parasite establishment, as well as parasite aggregation, varied significantly between the nine different settings, contributing to locally varying filarial elimination thresholds. Parasite elimination thresholds predicted for the settings in which the mosquito vector is anopheline were, however, found to be higher than those in which the mosquito is culicine, substantiating our previous theoretical findings. The results also indicate that the probability that the parasite will be eliminated following six rounds of Mass Drug Administration with diethylcarbamazine and albendazole decreases markedly but non-linearly as the annual biting rate and parasite reproduction number increases.ConclusionsThis paper shows that specific ecological conditions in a community can lead to significant local differences in population dynamics and, consequently, elimination threshold estimates for lymphatic filariasis. These findings, and the difficulty of measuring the key local parameters (infection aggregation and acquired immunity) governing differences in transmission thresholds between communities, mean that it is necessary for us to rethink the utility of the current anticipatory approaches for achieving the elimination of filariasis both locally and globally.

The multiplicity of malaria transmission: a review of entomological inoculation rate measurements and methods across sub-Saharan Africa.

Plasmodium falciparum malaria is a serious tropical disease that causes more than one million deaths each year, most of them in Africa. It is transmitted by a range of Anopheles mosquitoes and the risk of disease varies greatly across the continent. The "entomological inoculation rate" is the commonly-used measure of the intensity of malaria transmission, yet the methods used are currently not standardized, nor do they take the ecological, demographic, and socioeconomic differences across populations into account. To better understand the multiplicity of malaria transmission, this study examines the distribution of transmission intensity across sub-Saharan Africa, reviews the range of methods used, and explores ecological parameters in selected locations. It builds on an extensive geo-referenced database and uses geographical information systems to highlight transmission patterns, knowledge gaps, trends and changes in methodologies over time, and key differences between land use, population density, climate, and the main mosquito species. The aim is to improve the methods of measuring malaria transmission, to help develop the way forward so that we can better assess the impact of the large-scale intervention programmes, and rapid demographic and environmental change taking place across Africa.

Proximal Variables in Families of Children Prenatally Exposed to Cocaine and Enrolled in a Center- or Home-Based Intervention

The present study examined proximal variables in families of children prenatally exposed to cocaine and enrolled in a large-scale intervention program. Fifty-six high-risk families of children enrolled in the center-based (n = 30) or home-based (n = 26) intervention of the Linda Ray Intervention Program were interviewed. Four proximal variables were assessed: (a) quality of the caregiving environment, (b) family's regularity and predictability of daily routines, (c) caregiver's perception of the family's adequacy of resources, and (d) frequency and intensity of caregiver's experience with daily hassles. Results suggested that families of children enrolled in the center-based condition had more predictable daily routines than families of home-based participants. A family's adequacy of resources influenced the quality of the caregiving environment. Families with adequate resources were more likely to provide daily routines. Caregivers with fewer years of education were less able to establish and maintain daily routines which predicted, in part, a poorer caregiving environment.

The Maryland WIC 5 A Day Promotion Program Pilot Study: Rationale, Results, and Lessons Learned

Although the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) serves approximately 6.5 million participants nationwide, little research has been conducted to assess the effectiveness of health promotion programs aimed at the prevention of chronic diseases among its participants. Characteristics of the WIC program and the population it serves present numerous challenges to successfully implementing such initiatives. This National Cancer Institute-funded study seeks to increase fruit and vegetable consumption among women enrolled in WIC and women whose children are enrolled in WIC in Maryland. Key behavioral messages, motivators, and strategies tailored to the target population were identified first. The project team then developed a multifaceted intervention program. To assess its effectiveness and to learn about potential logistical problems prior to initiating a large-scale intervention program, we conducted a pilot study in two intervention sites and one control site. The pilot study demonstrated problems in client recruitment and participation. Both intervention sites showed small increases in fruit and vegetable consumption that were not statistically significant. Numerous lessons were learned, demonstrating the utility of conducting such a study prior to implementing a full-scale intervention.

Community surveillance of cardiovascular diseases in the Stanford Five-City Project. Methods and initial experience.

The Stanford Five-City Project is a long-term field evaluation of the effects of community health education on cardiovascular disease risk factors and event rates. One major end point of the project is the difference between treatment and control group trends in morbidity and mortality rates ascertained through community-wide surveillance of deaths and hospital discharges. This surveillance system includes continuous review of death certificates and hospital discharge records, interviews with the families and physicians of decedents who died outside the hospital, abstraction of the hospital records of possible myocardial infarction and stroke cases (fatal and nonfatal), and systematic validation of diagnosis by the use of standard criteria. Initial experience with information access, availability of diagnostic information, costs, and reliability are described. This standardized approach to community surveillance of cardiovascular disease events rates, both fatal and nonfatal, is a feasible method for evaluating large-scale intervention programs and may be applicable to monitoring secular trends in the absence of intervention.