A formative cross-sectional study to assess caregiver's health-seeking behaviour and knowledge surrounding malaria, and understand the burden of malaria among children under-five in conflict-affected communities of Cameroon

BACKGROUND

Malaria remains a major global health problem often worsened by political instability and armed conflict. The purpose of the study was to explore community knowledge, attitudes and practices on malaria prevention, and to understand the burden of malaria and health-seeking behaviours of caregivers of children under-five in conflict-affected communities of the South West and Littoral Regions of Cameroon.

METHODS

A cross-sectional survey involving internally displaced persons (IDPS), host population, and their children under-five was conducted across 80 communities. The survey was conducted from May to June 2021. Participants were interviewed using a structured questionnaire. Malaria prevalence for children under-five was determined using rapid diagnostic tests (RDT) on blood samples. Association between variables and displacement status was measured using chi square test and multivariate logistic regression model was fitted to identify factors associated with adequate knowledge on malaria prevention.

RESULTS

A total of 2386 adults participated in the study and 1543 RDTs were conducted for children under-five. Adequate levels of knowledge and attitudes on malaria prevention was recorded among 1258 (52.9%) of the participants, with very strong evidence to suggest the level to be higher among the host (59.5%) compared to the IDPs (49.5%) and returnees (39.7%) (p < 0.001). Good practices towards malaria prevention was 43.3%, with very strong evidence indicating lower levels among IDPs (42.8%) and returnees (28.5%) compared to the host (49.4%) (p < 0.001). Malaria prevalence for children under-five was 54.0% and adequate health-seeking for suspected episodes of malaria was 53.0%, without any difference among IDPs (51.78%) and returnees (48.7%) compared to host populations (55.4%) (p = 0.154). Multivariate logistic regression model showed that there was quite strong evidence to suggest primary and secondary levels of education have higher odds of having correct knowledge of malaria prevention (adjusted odds ratio (AOR) 1.71, 95% confidence interval (CI): 1.11-2.64, p = 0.015 and AOR 1.80, 95% CI 1.15-2.82, p = 0.010 respectively). There was very strong evidence to suggest that owning a radio or a television was associated with greater odds of having a higher knowledge on malaria prevention (AOR 1.49, 95% CI 1.233-1.81, p = 0.000 and AOR 1.47, 95% CI 1.18-1.84, p = 0.001).

CONCLUSION

Over half of the population have correct knowledge and attitudes towards malaria prevention but gaps in complete knowledge remained. Some of the caregivers know the correct malaria preventive practices coupled with largely unsatisfactory treatment approaches and reflected by the high prevalence of malaria among their children. In order to effectively treat malaria, innovative strategies should target community participation.

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia

Background

Pneumonia remains the leading cause of mortality in under-five children outside the neonatal period. Progress has slowed down in the last decade, necessitating increased efforts to scale up effective pneumonia interventions.

Methods

We used the Lives Saved Tool (LiST), a modelling software for child mortality in low- and middle-income settings, to prospectively analyse the potential impact of upscaling pneumonia interventions in Bangladesh, Chad, and Ethiopia from 2023 to 2030. We included Haemophilus influenzae type B (Hib) vaccination, pneumococcal conjugate vaccine (PCV), oral antibiotics, pulse oximetry, and oxygen as pneumonia interventions in our analysis. Outcomes of interest were the number of pneumonia deaths averted, the proportion of deaths averted by intervention, and changes in the under-five mortality rate.

Findings

We found that 19 775 lives of children under-five could be saved in Bangladesh, 76 470 in Chad, and 97 343 in Ethiopia by scaling intervention coverages to ≥90% by 2030. Our estimated reductions in pneumonia deaths among children under five range from 44.61% to 57.91% in the respective countries. Increased coverage of oral antibiotics, pulse oximetry, and oxygen show similar effects in all three countries, averting between 18.80% and 23.65% of expected pneumonia deaths. Scaling-up PCV has a prominent effect, especially in Chad, where it could avert 14.04% of expected pneumonia deaths. Under-five mortality could be reduced by 1.42 per 1000 live births in Bangladesh, 22.52 per 1000 live births in Chad, and 5.48 per 1000 live births in Ethiopia.

Conclusions

This analysis shows the high impact of upscaling pneumonia interventions. The lack of data regarding coverage indicators is a barrier for further research, policy, and implementation, all requiring increased attention.

Supporting Bystanders and Other Staff Exposed to Negative Workplace Behaviour: Developing and Testing the IMO Intervention Framework in the Clinical Workplace

BACKGROUND

Medical student and health-care staff bullying remain international concerns. Our understanding about what might solve such problems is still developing. A common approach suggested for bystanders to bullying is that they challenge or "stand up" to the bully. At the same time, the considerable risks should they act (eg, verbal rebuke) are rarely acknowledged, and neither is the potential for considerable cognitive dissonance should they choose not to.

METHODS

Drawing on a substantial literature review, we developed an interventional program, initially with medical student bullying in mind, that generally employed a discourse for values cultivation. We implemented and evaluated this program through 6 cycles of action research methodology in 6 different departments of one tertiary teaching hospital. Data include individual interviews, discussions with key participants plus freehand comments from wider staff's workshop evaluations.

RESULTS

Alongside others, an early serendipitous finding was the "IMO" [Indirect, focus on Me, focus on Outcome] framework, intended for bystanders to student bullying. From using this framework, participants reported developing confidence in tackling negative behaviours, that interactions had better outcomes and that the workplace atmosphere felt more relaxed. It's use also significantly reduced cognitive dissonance. Encouragingly, participants went on to use IMO for staff-staff bullying incidents, and other common negative behaviours. We attribute IMO's utility to its memorability, simplicity and for catering to the many possible causes of bullying, including values issues, without perpetuating or creating conflict.

CONCLUSION

The IMO framework is offered as a widely usable framework for all staff in a clinical environment - a useful addition to popular frameworks used in the clinical workplace, ideas from which might also help these be further refined. Further evaluation would establish whether IMO invites long-term change and its utility in other contexts.

Plant endosomes as protein sorting hubs

Endocytosis, secretion, and endosomal trafficking are key cellular processes that control the composition of the plasma membrane. Through the coordination of these trafficking pathways, cells can adjust the composition, localization, and turnover of proteins and lipids in response to developmental or environmental cues. Upon being incorporated into vesicles and internalized through endocytosis, plant plasma membrane proteins are delivered to the trans-Golgi network (TGN). At the TGN, plasma membrane proteins are recycled back to the plasma membrane or transferred to multivesicular endosomes (MVEs), where they are further sorted into intralumenal vesicles for degradation in the vacuole. Both types of plant endosomes, TGN and MVEs, act as sorting organelles for multiple endocytic, recycling, and secretory pathways. Molecular assemblies such as retromer, ESCRT (endosomal sorting complex required for transport) machinery, small GTPases, adaptor proteins, and SNAREs associate with specific domains of endosomal membranes to mediate different sorting and membrane-budding events. In this review, we discuss the mechanisms underlying the recognition and sorting of proteins at endosomes, membrane remodeling and budding, and their implications for cellular trafficking and physiological responses in plants.

Measuring exposure to bullying and harassment in health professional students in a clinical workplace environment: Evaluating the psychometric properties of the clinical workplace learning NAQ-R scale

Background: Instruments that measure exposure to bullying and harassment of students learning in a clinical workplace environment (CWE) that contain validity evidence are scarce. The aim of this study was to develop such a measure and provide some validity evidence for its use.Method: We took an instrument for detecting bullying of employees in the workplace, called the Negative Acts Questionnaire - Revised (NAQ-R). Items on the NAQ-R were adapted to align with our context of health professional students learning in a CWE and added two new factors of sexual and ethnic harassment. This new instrument, named the Clinical Workplace Learning NAQ-R, was distributed to 540 medical and nursing undergraduate students and we undertook a Confirmatory Factor Analysis (CFA) to investigate its construct validity and factorial structure.Results: The results provided support for the construct validity and factorial structure of the new scale comprising five factors: workplace learning-related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying (PIB), sexual harassment (SH), and ethnic harassment (EH). The reliability estimates for all factors ranged from 0.79 to 0.94.Conclusion: This study provides a tool to measure the exposure to bullying and harassment in health professional students learning in a CWE.

Interventions addressing student bullying in the clinical workplace: a narrative review

BACKGROUND

Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effective. With this narrative review about student bullying interventions in the clinical learning environment, we examine and draw together the available, but patchy, information about 'what works' to inform better practice and further research.

METHODS

We initially followed a PICO approach to obtain and analyse data from 38 articles from seven databases. We then used a general inductive approach to form themes about effective student bullying intervention practice, and potential unintended consequences of some of these, which we further developed into six final themes.

RESULTS

The diverse literature presents difficulties in comparison of intervention efficacy and substantive guidance is sparse and inconsistently reported. The final analytical approach we employed was challenging but useful because it enabled us to reveal the more effective elements of bullying interventions, as well as information about what to avoid: an interventionist and institution need to, together, 1. understand bullying catalysts, 2. address staff needs, 3. have, but not rely on policy or reporting process about behaviour, 4. avoid targeting specific staff groups, but aim for saturation, 5. frame the intervention to encourage good behaviour, not target poor behaviour, and 6. possess specific knowledge and specialised teaching and facilitation skills. We present the themed evidence pragmatically to help practitioners and institutions design an effective program and avoid instigating practices which have now been found to be ineffective or deleterious.

CONCLUSIONS

Despite challenges with the complexity of the literature and in determining a useful approach for analysis and reporting, results are important and ideas about practice useful. These inform a way forward for further, more effective student bullying intervention and research: an active learning approach addressing staff needs, which is non-targeted and positively and skilfully administered. (331w).

"They cared about us students:" learning from exemplar clinical teaching environments

PURPOSE

In order to foster positive student experiences in the clinical learning environment, we wanted to better understand which teaching practices they regard highly.

METHODS

In 2016, the authors undertook a paper 'exemplar' survey (ES) of all fifth year medical students at one tertiary teaching site. Students had experienced all assigned clinical rotations over a two year period. Following a 66% response rate, we identified two clear exemplar clinical areas (ECAs). Over 2016-7, six focus groups with multidisciplinary staff members from these clinical areas were held, with the aim to identify, discuss and understand their specific teaching practices in more detail.

RESULTS

The authors present descriptions of positive student experiences and related staff practices, in five themes. Themes emerged around foundational logistic and personal factors: central to student and staff data is that 'welcome' on a daily, and ongoing basis, can be foundational to learning. Central to ECA staff data are universal practices by which all staff purposefully work to develop a functional staff-student relationship and play a part in organising/teaching students. Students and ECA staff groups both understood teacher values to be central to student learning and that cultivating a student's values is one of their major educational tasks.

CONCLUSIONS

The framework formed by this thematic analysis is useful, clear and transferrable to other clinical teaching contexts. It also aligns with current thinking about best supporting student learning and cultivating student values as part of developing professionalism. Instigating such practices might help to optimise clinical teaching. We also tentatively suggest that such practices might help where resources are scarce, and perhaps also help ameliorate student bullying.

Time to stop making things worse: an imperative focus for healthcare student bullying research

Student bullying in clinical practice remains a concern, and evidence regarding what works to specifically help the student appears rather piecemeal. At the same time, emergent literature indicates that some bullying interventions can be ineffective for behaviour change, or even deleterious to the staff which they target. Considering the potentially sizeable financial and personal costs associated with continued bullying and undertaking an intervention, it would seem sensible that any selected intervention method avoids those shown to be potentially ineffective or deleterious. Such avoidance would likely help to move the student bullying research forward, prevent further suffering and reduce the waste of valuable taxpayer resources.

Bone parameters are improved with intermittent dosing of vitamin D3 and calcitonin

Intermittent combination of an anabolic agent to promote bone formation and an antiresorptive agent that would prevent further bone loss is a theoretically attractive approach for restoring bone mass. We tested the potential of intermittently dosed calcitriol and calcitonin (CT) to restore bone properties in ovariectomized (Ovx) rats. Rats had Ovx or sham surgery at 8 weeks old and 4 weeks later were assigned to experimental groups: (1) sham vehicle, (2) Ovx vehicle, (3) Ovx + parathyroid hormone (PTH, 40 microg/kg), and (4) Ovx + calcitriol (2 microg/kg) + CT (2 microg/kg). Group 3 received PTH every week throughout the study, and group 4 received calcitriol at weeks 1, 3, 5, and 7 and CT at weeks 2, 4, 6, and 8. Dosing was carried out for 8 weeks with serum, and micro-computed tomographic analysis was done at 0, 4, and 8 weeks. Femurs and tibias were used for radiological analyses and for mechanical testing. Dosing with PTH improved bone mass and structure of cancellous bone at metaphyses of tibias and femurs as well as properties of cortical bone including geometry and strength. Intermittent dosing with calcitriol and CT was less potent in correcting loss of cancellous bone relative to treatment with PTH and had no effect on cortical bone parameters. However, intermittent dosing with calcitriol and CT was robust enough to improve cancellous bone mass and structure through bone formation without causing deleterious side effects. Our data provide additional evidence that therapies can be devised to ameliorate the skeletal defects associated with established osteoporosis.

Pancreatic cancer survivorship: Intrathecal drug delivery system for pain management

14100

Background: Pancreatic cancer is predominantly unresectable at diagnosis and is most frequently fatal. Nationally the average survivorship is 10 months. Among pancreatic cancer patients, pain is associated with decreased survival rates. Quality of life and survivorship are the principal outcome measures for these patients. Successful pain management may be a significant predictor of prolonged survivorship. No study has demonstrated an impact on survivorship secondary to the treatment of pancreatic cancer pain and the use of Intrathecal Drug Delivery Systems (IDDS). Methods: A retrospective chart review identified all pancreatic cancer patients treated at a cancer pain treatment center between January 2002 and June 2005. 43 patients had known dates of diagnosis and known dates of death. The Arizona Department of Health Services Cancer Registry provided similar information for pancreatic cancer patients residing in Maricopa County for that time period. 713 Maricopa county residents had known dates of diagnosis and known dates of death. Results: Among the Maricopa County pancreatic cancer patients, the mean survivorship was 5 months. Among the treatement center patients who did not receive the IDDS for pain, 10 (23.3%), the mean survivorship was 10.8 months. Among the pancreatic cancer patients receiving IDDS for pain management, 33 (76.7%), the mean survivorship was 14.2 months. Mean survivorship among the treatment center patients receiving IDDS for pain management is nearly 3 times greater than the general survivorship of pancreatic cancer patients in Maricopa County. Among the treatement center patients the mean survivorship is nearly 50% greater for patients receiving IDDS versus those that did not. Conclusions: The implantable IDDS for pain management among pancreatic cancer patients may be a significant predictor of increased survivorship. A larger sample size may be needed to detect significant differences in survivorship. Controlled studies examining survivorship as the primary outcome for patients with unresectable pancreatic cancer by evaluating the implantable IDDS as compared to usual care modalities such as comprehensive medical management (CMM) or neurolytic celiac plexus block (NCPB) for pain management are warranted.

No significant financial relationships to disclose.