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Subjective Evaluation of Female Adult Body Fat Distribution: A Scoping Review.
Get PDFBody fat distribution is a key indicator of obesity-related disease risk, often assessed through objective anthropometric measurements. However, objective implementation at scale is limited by measurement variability, cost, and anthropometrist skill. Subjective methods, widely applied in body image research, may offer an alternative but are less explored for determining obesity- and disease-related risk. This scoping review aimed to identify the availability and characteristics of subjective body shape assessment tools for assessing regional body fat distribution in adult females. A search across five databases (inception to September 8, 2023), using terms for body shape and assessment tools, limited to females, yielded 13,646 unique records; 177 studies were included, reporting 80 tools (13 were variations of 7 originals). Studies utilized tools for varied purposes: body image/shape attractiveness, satisfaction, or distortion (73.4%); health/disease risk (18.1%); tool development/validation (13.0%); clothing/fashion (5.6%); or other (4.0%). Tools types included: figural (38.8%); photographic (21.3%); silhouette (16.3%); figural/scanned image with shape overlay (6.3%); computer generated image (6.3%); inanimate shape (3.8%); somatograph (1.3%); and unclassified (6.3%). Some tools were culturally adapted (e.g., modifying skin tone, clothing, or shape to the population), but most (17.6% of 51 applicable tools) depicted White ethnicity, limiting inclusivity. Among applicable tools, 56.3% included facial features, and 25.4% nakedness. This review reveals a variety of subjective tools, but limited application for disease-related risk assessment. Further research should refine and culturally adapt subjective tools to ensure conceptual suitability, and validate their use for assessing obesity-related disease risk
The ABILHAND-23 Patient Reported Outcome Measure in Secondary Progressive Multiple Sclerosis: A Cross-Sectional Analysis With the Nine Hole Peg Test.
Get PDFBACKGROUND: People with progressive multiple sclerosis (pwPMS), who typically have established lower limb dysfunction, experience greater disability from upper limb dysfunction (ULD). The 9-hole peg test (9HPT) is the primary clinical measure for ULD but does not fully capture the patient experience. The ABILHAND-23 is a well-validated patient-reported outcome measure (PROM) that evaluates bimanual ability in daily function. However, no large-scale studies have assessed if the 9HPT reflects the individual ULD experience in pwPMS.
OBJECTIVES: We sought to (van Munster et al. 2023) assess the associations between the ABILHAND-23 and 9HPT, and (Huertas-Hoyas et al. 2020) to assess the ability of the 9HPT and other relevant covariables to predict ABILHAND-23 scores, using baseline data from the MS-STAT2 trial, a phase 3 study on simvastatin for secondary progressive MS (SPMS).
METHODS: A cross-sectional analysis of baseline data from the UCLH cohort of the MS-STAT2 trial was performed using multiple linear regression to predict ABILHAND-23 logit scores by 9HPT.
RESULTS: 225 participants were analyzed. ABILHAND-23 scores moderately correlated with the 9HPT (rho = 0.47). Regression analysis showed that better 9HPT performance modestly predicted ABILHAND-23 logits (β = -0.05, SE 0.008, p-value < 0.001).
CONCLUSION: The 9HPT only modestly predicts the ABILHAND-23 but does not fully capture the individual's daily disability experience, underscoring the value of patient-reported outcome measures (PROMs) like the ABILHAND-23 in clinical trials
Responsibility without autonomy: exploring the emergence of distributed leadership in a district hospital of the Western Cape province, South Africa.
No full textDistributed leadership has been proposed to offer value for health systems-by enabling people to work towards collective goals within settings such as hospitals. Yet, there is still limited empirical exploration of its dynamics in practice, especially in low- and middle-income contexts. To address this knowledge gap, this case study draws on conceptual work in empirically examining leadership in one district hospital in the Western Cape province, South Africa, seeking to identify evidence of distributed leadership and the factors influencing its emergence. Data were extracted from 28 academic theses, policies and strategic documents relating to health leadership, management and governance in the provincial health system (Phase 1) and 12 semi-structured, in-person interviews were conducted with hospital personnel (Phase 2). Phase 1 data provided the context of the case and guided the collection of data in Phase 2. All data were thematically analysed. The analysis reveals that there were pockets of distributed leadership within the hospital, as characterized by chains of multiple leaders working together to co-create shared meaning, take collective decisions and achieve common goals, enabled by relational leadership practices. These pockets supported both routine service delivery and bottom-up service improvement action. However, the unequal distribution of decision-making power, in the context of bureaucratic and professional hierarchies, limited the widespread emergence of distributed leadership. The case study suggests that distributed leadership can emerge in district hospitals with positive consequences for health service delivery, but that efforts to nurture its emergence should both bolster the leadership capabilities of individual leaders and address the bureaucratic and professional hierarchies that characterize the context within which hospital leadership unfolds. To aid the future practice of, and research about, distributed leadership the paper proposes a comprehensive definition of the concept, derived from the combination of wider literature and this study's empirical findings
Novel zoonotic cases of Plasmodium simium from São Paulo with a reference genome of the Brazilian strain.
Get PDFZoonotic malaria, caused by parasites like Plasmodium simium, poses challenges to control and elimination efforts due to undetected reservoirs and altered transmission dynamics. Recent outbreaks in Brazil underscore the importance of P. simium spillovers from non-human primates. Genomic studies are crucial for identifying molecular markers of host adaptation and improving diagnostic tools; however, a high-quality reference genome is needed. To address this, we used Oxford Nanopore and Illumina sequencing platforms to generate a high-quality P. simium reference (Ps_SãoPaulo, 21.8 Mb). Comparative genomic analyses confirmed known differences with P. vivax, including mitochondrial mutations, deletions in reticulocyte-invasion genes (RBP2a, DBP), and variants in blood-stage antigen genes (msp3.1, msp3.2). Genome-wide analyses of 38 P. simium samples from Brazil revealed expected divergence from P. vivax and potential unique signatures of selection and host adaptation. This study provides the most comprehensive P. simium reference genome, advancing our understanding of its genomic diversity, with insights for malaria control in Brazil
Comparative genomic insights into multidrug resistance in classical and hypervirulent K. pneumoniae clinical isolates.
Get PDFKlebsiella pneumoniae is a highly adaptable opportunistic pathogen responsible for various infections, particularly in immunocompromised individuals. The recent genetic evolution of K. pneumoniae has led to the emergence of strains exhibiting both hypervirulence and multidrug resistance (MDR). In this study, we compared the genomic characteristics of MDR in classical and hypervirulent K. pneumoniae clinical isolates. Sixty-four isolates were collected from two healthcare institutions in Khyber Pakhtunkhwa, Pakistan, and identified using standard microbiological techniques. Whole-genome sequencing (WGS) was performed on 30 selected isolates using an Illumina platform. The sequencing data were analysed with the Kleborate tool. WGS analysis identified sequence types ST147 (n = 7, 23%) and ST2629 (n = 5, 16.6%) as the most prevalent lineages. Additionally, 13 other ST were detected, including ST147-1LV (n = 1, 3.3%) and ST859 (n = 1, 3.3%), which exhibited hypervirulent MDR traits. Among K-loci-associated virulence determinants, KL64 was the most predominant (n = 7, 23%), while the O-serotype O1/O2v1 was found in 22 isolates. A diverse range of antimicrobial resistance (AMR) determinants was observed across isolates. Plasmid-mediated quinolone resistance (PMQR) genes (qnrS1, qnrB1, qnrB4, qepA2) and aminoglycoside-modifying enzymes (aac(3)-IIa, aac(6')-Ib-cr, strA, strB) were detected in both classical and hypervirulent strains. β-lactamase genes included bla-SHV variants (bla-SHV-1, bla-SHV-11, bla-SHV-25, bla-SHV-187), bla-CTX-M-15, bla-VEB-5, bla-OXA-1, bla-OXA-48, and bla-OXA-181. Additional resistance genes conferred resistance to macrolides (ermB, mphB), phenicols (catB4, catA1, floR), sulfonamides (sul1, sul2), tetracyclines (tetA, tetB, tetD), and trimethoprim (dfrA1, dfrA12, dfrA14). Acquired AmpC and other β-lactamases (DHA-1, TEM-1D, CMH-1, CMY-6, LAP-2, AmpC1) were also present. The most prevalent plasmid replicons were Col(pHAD28), IncFIB(K), and IncR, with the hypervirulent ST147-1LV isolate carrying the highest number. These findings underscore the significant public health threat posed by hypervirulent and MDR K. pneumoniae strains, highlighting the extensive burden of virulence and resistance genes that complicate treatment strategies
Defying barriers to fight tuberculosis in West Africa: a model of equitable partnerships within a research capacity-strengthening network in the subregion.
Get PDFTuberculosis (TB), caused by the Mycobacterium tuberculosis complex (MTBC), is the leading cause of death from a single infectious disease, despite being treatable. Global TB control efforts face significant challenges, including insufficient funding, ineffective vaccines, inadequate diagnostics, and complex treatments, particularly in resource-limited regions. West Africa has a unique TB epidemiology, characterized by medium- to high-prevalence rates and a greater diversity of the MTBC, which further compounds control efforts. In response to the global call to end TB by 2030, the West African Network of Excellence for TB, AIDS, and Malaria (WANETAM) has united scientists from 25 institutions across 12 West African countries to build research capacity and conduct translational research focused on TB. The multi-country program of WANETAM focuses on assisting the TB control programs of its member countries through the supply of essential laboratory equipment and the facilitation of laboratory accreditation/certification (with three regional laboratories already ISO accredited and others on track). The program also emphasizes gender-sensitive training, the retention of critical laboratory and research expertise, improvements in the diagnosis of TB (including pediatric and drug-resistant forms), and conducting studies on TB to better understand the molecular epidemiology of the MTBC in the sub-region, thereby generating the evidence to inform the policy. To date, WANETAM has trained 13 postdoctoral fellows, 753 laboratory technicians/technologists, and currently supports 7 female PhD students in the final year of their respective programs. By fostering collaboration among Francophone, Anglophone, and Lusophone West Africans, WANETAM is bridging cultural and language barriers to fight TB while also preparing West Africa for future pandemics
Automated reporting of primaquine dose efficacy, tolerability and safety for Plasmodium vivax malaria using a systematic review and individual patient data meta-analysis.
Get PDFBACKGROUND: The antirelapse efficacy of primaquine is related to the total dose administered, whereas the risks of haemolysis and gastrointestinal intolerance are associated with the daily dose administered. National Malaria Control Programmes require local information on efficacy, tolerability and safety to optimize antimalarial treatment policies for Plasmodium vivax malaria control and elimination efforts. METHODS: A living systematic review identified efficacy studies of uncomplicated P. vivax malaria including patients treated with daily primaquine regimens, published since January 1, 2000. Available data were pooled and an R Shiny app was developed to integrate statistical analyses performed using R and Stata that assessed the impact of primaquine mg/kg dose on efficacy, hematological safety and gastrointestinal tolerability. RESULTS: As of January 16, 2025, a total of 9,270 individual patient data records from 41 studies have been collated into the standardized repository. Open-access automated reports were generated for user-selected countries or regions to investigate location specific effects of primaquine dose on efficacy, safety and tolerability. The reports include visual and tabular displays of the outcomes. CONCLUSIONS: These automated reports leverage a large database to provide accessible data for national and regional policy makers and researchers to assess the clinical consequences of different primaquine regimens in different endemic settings. The reports will inform local and regional policy decisions and research priorities in vivax-endemic areas
The 'knowing' body in the becoming of buprenorphine depot treatment: A qualitative study.
Get PDFThere is a tendency to approach the body as if passive, and as acted upon, in medical treatment studies. We undertook a longitudinal qualitative study of monthly buprenorphine depot, with 36 participants (25 men, 11 women; of whom 32 were followed up over three years). Our analysis draws attention to the body as an active actor in the becoming of buprenorphine depot treatment. We trace two scenarios of agency in which bodies participate. The first is discovery and surprise. These are situations in which the body 'speaks', giving feedback in relation to its treatment, and contributing to an iterative process of learning. The second scenario is experimentation. Here, bodily feedbacks inform reasoned actions which give rise to purposeful experimentations in which the body is 'put to the test' or invited into a 'trial' of conjoint learning. Taken together, we show how the body plays a critical role in how buprenorphine treatment 'comes to be known' and how such treatment is made 'workable' in its situation. Our findings emphasize how clinical encounters might better listen to, and learn from, bodies in the implementation of treatments. A priori evidence-based standards and guidelines often shape clinical decisions, but there are other forms of situated and embodied knowing. Bodies are active in shaping what buprenorphine depot treatment comes to be
Nurses experiences with an intervention enhancing skill-mix in Kenyan neonatal units with severe workforce deficits: A qualitative study.
Get PDFBACKGROUND: Nurses remain critical in newborn care delivery in Kenya. However, persistent nurse shortages in newborn units limit their ability to provide optimal care. Staff shortages contribute to missed care and high workloads, negatively impacting the motivation and well-being of nurses. Evidence from Low and middle-income countries reveals strategies employed by nurses to manage high workloads. These include prioritisation of care and informal task shifting, where tasks are delegated to caregivers, student nurses, and support staff. While sharing and shifting non-technical tasks to less qualified personnel may be helpful, perceptions linked to the cadre of staff taking on extra roles and effects on the care performed and other critical relational aspects of care are often unclear or overlooked. To generate evidence on the impact of staffing interventions, we investigated the effects of workforce interventions on supporting neonatal care in hospitals in Kenya. In this paper, we report on the experiences of nurses with the intervention. METHODS: We adopted an ethnographic approach to explore nurses experiences with a staffing intervention in four Kenyan newborn units (neonatal units). Non-participant observations on neonatal units and in-depth interviews were conducted with healthcare providers. Data collection occurred in three phases: at baseline (Phase 1), after supplementing the units with additional nurses (Phase 2), and after supplementing the units with ward assistants (Phase 3). Over 1000 hours of observations and 112 in-depth interviews were conducted between January 2022 and July 2023. Drawing from the project's theory of change, we used a thematic approach in analysing and interpreting the data. RESULTS: Additional nurses and ward assistants were perceived as contributing to the overall motivation and well-being of existing nurses. Additional nurses meant that there were more hands per shift, which enhanced teamwork, task sharing, and task completion. The reported benefits of having more ward assistants included nurses being able to delegate non-technical tasks to ward assistants, which reduced nurses workload and freed up their time to concentrate on critical nursing tasks. This contributed to improved nurse motivation and well-being. CONCLUSIONS: Adequate staffing is crucial for delivering optimal care quality and is central to nurses well-being. There is a need to increase nurse staffing in neonatal units. Further beneficial support for nurses may be gained by carefully designing and implementing non-technical task-sharing roles
Integrated assessment of farm-level mitigation measures for gaseous emissions
Get PDFContext: Some gaseous emissions continue to pose a serious threat to human health and the environment locally, regionally and globally. This has resulted in several studies advocating for the implementation of mitigation measures to reduce the emissions of harmful gases. Objective: While the vast majority of studies focus on a single type of gas, much less attention has been paid to the complementary or conflicting effects of mitigation measures across multiple harmful gaseous emissions dimensions. Methods: To address this research gap, this study uses Irish farm-level data to assess the holistic costs and benefits of a suite of mitigation measures that have the potential to abate greenhouse gases, ammonia or both. A cost-benefit analysis framework is employed to assess the impact of the mitigation measures across five different farm system types. Results and conclusions: Results indicate that the relative effectiveness of the mitigation measure varies depending on the gaseous emission dimension being examined. Significance: Analyses that fail to account for such synergistic and antagonistic relationship impacts may lead to flawed policy decisions