Suchergebnisse

ObjectivesOur objective was to capture a holistic view of a child from "society to cell" by building an inter-disciplinary data linkage between social, biological, and environmental factors to better understand how "experience gets under the skin" to influence social disparities in child development from conception onwards.
ApproachLinking a unique combination of administrative, survey, and biological data, this research connects children's epigenetic profiles and other biological markers (e.g., microbiome) to broader social determinants of health to examine the process of "biological embedding." In British Columbia, Canada, the CHILD Study has collected biological data for a cohort of children from birth to age 5 (N = 840). Linked administrative records (e.g., health services, demographic data) provide key social and environmental information (e.g., parental depression, neighbourhood socio-economic status). Population-level child development data have been collected at age 5 using the Early Development Instrument and are linkable for a subset of this cohort (N ~ 250).
ResultsThis unique linkage helps us understand the critical interplay between health outcomes and resulting disparities; how a child's social environment may impact their biological makeup, and in turn their health and developmental outcomes due to influences on their neural, endocrine, and/or immune systems at the molecular level. Rather than limiting research to singular disciplines, this research aims to shift thinking around health problems towards a synthesized model to examine mechanisms and associations between early experiences and biological outcomes. We will discuss strengths and challenges of developing this linkage and working across disciplines such as medicine, education, and science to address research questions that span historically disparate areas of research.
ConclusionAn interdisciplinary approach has been essential for the development and approvals of this project. Bringing together experts from diverse disciplines with different perspectives to use a novel approach enables us to better address the large and important issue of childhood social disparities and their enduring impact on life course health.

ObjectivesChildren who are new to Canada have unique circumstances that can be associated with their emotional health. Using linked immigration and child self-report data, we examined associations between changes in children's social support and emotional health from ages 9 to 12, for immigrant, refugee, and non-immigrant children.
ApproachA population sample of N = 4664 immigrant, refugee, and non-immigrant children reported on their peer support and school belonging, as well as their emotional health (life satisfaction, self-esteem, sadness), in Grades 4 and 7. Social support and emotional health were measured using the Middle Years Development Instrument (MDI). Migration background including age at arrival, migration class, generation status, and source region, was obtained from the Immigration, Refugees, and Citizenship Canada database, individually linked to MDI records using children's Personal Education Number and child date of birth. Multi-level modelling assessed associations adjusting for confounders.
ResultsIn the linked sample, 19% of children were first- or second-generation economic immigrants (themselves or their parents were born outside of Canada), 8% were family immigrants, and 5% were refugees. Children with refugee backgrounds reported lower life satisfaction and self-esteem and higher sadness in Grade 4 compared to all other groups. Children with immigration backgrounds reported lower life satisfaction and self-esteem and higher sadness compared to non-immigrants. Refugee children had significantly more positive changes in emotional health from Grades 4 to 7 compared to non-immigrants, and significantly more positive changes in social supports. Positive changes in social supports were associated with positive changes in emotional health of similar magnitude for all children, regardless of migration background. Children with refugee backgrounds on average experienced improved emotional health during middle childhood, and changes in peer support partially accounted for these changes.
ConclusionResults suggest that children with migration backgrounds enter school with lower emotional health and are likely to benefit from increased social supports. Likewise, incorporating opportunities to build peer relationships and school belonging is likely to benefit all children, regardless of migration background.

Background. Despite the evidence showing the promise of HIV treatment as prevention (TasP) in reducing HIV incidence, a variety of ethical questions surrounding the implementation and "scaling up" of TasP have been articulated by a variety of stakeholders including scientists, community activists and government officials. Given the high profile and potential promise of TasP in combatting the global HIV epidemic, an explicit and transparent research priority-setting process is critical to inform ongoing ethical discussions pertaining to TasP. Methods We drew on the Arksey and O'Malley framework for conducting scoping review studies as well as systematic approaches to identifying empirical and theoretical gaps within ethical discussions pertaining to population-level intervention implementation and scale up. We searched the health science database PubMed to identify relevant peer-reviewed articles on ethical and implementation issues pertaining to TasP. We included English language articles that were published after 2009 (i.e., after the emergence of causal evidence within this field) by using search terms related to TasP. Given the tendency for much of the criticism and support of TasP to occur outside the peer-reviewed literature, we also included grey literature in order to provide a more exhaustive representation of how the ethical discussions pertaining to TasP have and are currently taking place. To identify the grey literature, we systematically searched a set of search engines, databases, and related webpages for keywords pertaining to TasP. Results Three dominant themes emerged in our analysis with respect to the ethical questions pertaining to TasP implementation and scale-up: (a) balancing individual- and population-level interests; (b) power relations within clinical practice and competing resource demands within health care systems; (c) effectiveness considerations and socio-structural contexts of HIV treatment experiences within broader implementation contexts. Conclusion Ongoing research and normative deliberation is required in order to successfully and ethically scale-up TasP within the continuum of HIV care models. Based on the results of this scoping review, we identify several ethical and implementation dimensions that hold promise for informing the process of scaling up TasP and that could benefit from new research. ; Graduate and Postdoctoral Studies ; Population and Public Health (SPPH), School of ; Other UBC ; Non UBC ; Medicine, Faculty of ; Reviewed ; Faculty

Abstract Background Despite the evidence showing the promise of HIV treatment as prevention (TasP) in reducing HIV incidence, a variety of ethical questions surrounding the implementation and "scaling up" of TasP have been articulated by a variety of stakeholders including scientists, community activists and government officials. Given the high profile and potential promise of TasP in combatting the global HIV epidemic, an explicit and transparent research priority-setting process is critical to inform ongoing ethical discussions pertaining to TasP. Methods We drew on the Arksey and O'Malley framework for conducting scoping review studies as well as systematic approaches to identifying empirical and theoretical gaps within ethical discussions pertaining to population-level intervention implementation and scale up. We searched the health science database PubMed to identify relevant peer-reviewed articles on ethical and implementation issues pertaining to TasP. We included English language articles that were published after 2009 (i.e., after the emergence of causal evidence within this field) by using search terms related to TasP. Given the tendency for much of the criticism and support of TasP to occur outside the peer-reviewed literature, we also included grey literature in order to provide a more exhaustive representation of how the ethical discussions pertaining to TasP have and are currently taking place. To identify the grey literature, we systematically searched a set of search engines, databases, and related webpages for keywords pertaining to TasP. Results Three dominant themes emerged in our analysis with respect to the ethical questions pertaining to TasP implementation and scale-up: (a) balancing individual- and population-level interests; (b) power relations within clinical practice and competing resource demands within health care systems; (c) effectiveness considerations and socio-structural contexts of HIV treatment experiences within broader implementation contexts. Conclusion Ongoing research and normative deliberation is required in order to successfully and ethically scale-up TasP within the continuum of HIV care models. Based on the results of this scoping review, we identify several ethical and implementation dimensions that hold promise for informing the process of scaling up TasP and that could benefit from new research.

Nurturing relationships are crucial for adaptive child development. The objectives of the study were to investigate whether nature availability was associated with early nurturing parenting practices, mother-infant bonding, and infant socioemotional function. Data were from the Australian Temperament Project ( n = 809 infants to 515 parents residing in Victoria, Australia) and were linked cross-sectionally to residential greenness (i.e., Normalized Difference in Vegetation Index). There were no observable associations between residential greenness within a 1,600 m network radius and parenting practices, mother-infant bonding, or infant socioemotional function. The findings were largely corroborated by sensitivity analyses (i.e., NDVI within 100, 250, 500, and 1,000 m and distance to park). Shorter distances to a park were associated with less hostile parenting. More residential greenness (1,000 and 1,600 m) was associated with stronger father-infant bonding and more hostile parenting amongst the most stressed parents in exploratory analyses. Residential greenness might be a socioecological precursor for father-infant bonding.

Findings from longitudinal research, globally, repeatedly emphasise the importance of taking an early life course approach to mental health promotion; one that invests in the formative years of development, from early childhood to young adulthood, just prior to the transition to parenthood for most. While population monitoring systems have been developed for this period, they are typically designed for use within discrete stages (i.e., childhood or adolescent or young adulthood). No system has yet captured development across all ages and stages (i.e., from infancy through to young adulthood). Here we describe the development, and pilot implementation, of a new Australian Comprehensive Monitoring System (CMS) designed to address this gap by measuring social and emotional development (strengths and difficulties) across eight census surveys, separated by three yearly intervals (infancy, 3-, 6-, 9- 12-, 15-, 18 and 21 years). The system also measures the family, school, peer, digital and community social climates in which children and young people live and grow. Data collection is community-led and built into existing, government funded, universal services (Maternal Child Health, Schools and Local Learning and Employment Networks) to maximise response rates and ensure sustainability. The first system test will be completed and evaluated in rural Victoria, Australia, in 2022. CMS will then be adapted for larger, more socio-economically diverse regional and metropolitan communities, including Australian First Nations communities. The aim of CMS is to guide community-led investments in mental health promotion from early childhood to young adulthood, setting secure foundations for the next generation.