Feminism and a View of Conservative Gender Roles among Young Working Women in Malaysia

People are often influenced by norms and ideologies, including the concepts of feminism and conservative gender roles. With perceptions evolving constantly, we intend to investigate the subject of feminism and the view of young working women in Malaysia with regards to conservative gender roles. Studies on the subject have been scarce or minimal so far, hence understanding the general population’s perception will allow us to better measure public awareness on the topic of our research. The demographic of participants in this study specifically encompasses working women, between the ages of eighteen and forty years old. The participants were recruited through virtual mediums, namely WhatsApp, Facebook and Instagram. They were then asked to participate in a semi-structured interview to aid in the collection of detailed data which was then analysed through the process of transcription and coding for recurring themes. The study suggests that young working women in Malaysia are more in tune with feminism than originally anticipated due to digital platforms. Among the inequalities faced in the workforce, the most cited are equal and fair pay. Family upbringing, tradition and culture were often cited as shaping the general evolution of gender roles. Research can be done on feminism, gender roles and their implications on the LGBT community as a whole

A model for leveraging animal movement to understand spatio-temporal disease dynamics

The ongoing explosion of fine-resolution movement data in animal systems provides a unique opportunity to empirically quantify spatial, temporal and individual variation in transmission risk and improve our ability to forecast disease outbreaks. However, we lack a generalizable model that can leverage movement data to quantify transmission risk and how it affects pathogen invasion and persistence on heterogeneous landscapes. We developed a flexible model ‘Movement-driven modelling of spatio-temporal infection risk’ (MoveSTIR) that leverages diverse data on animal movement to derive metrics of direct and indirect contact by decomposing transmission into constituent processes of contact formation and duration and pathogen deposition and acquisition. We use MoveSTIR to demonstrate that ignoring fine-scale animal movements on actual landscapes can mis-characterize transmission risk and epidemiological dynamics. MoveSTIR unifies previous work on epidemiological contact networks and can address applied and theoretical questions at the nexus of movement and disease ecology

Deriving spatially explicit direct and indirect interaction networks from animal movement data

Quantifying spatiotemporally explicit interactions within animal populations facilitates the understanding of social structure and its relationship with ecological processes. Data from animal tracking technologies (Global Positioning Systems [“GPS”]) can circumvent longstanding challenges in the estimation of spatiotemporally explicit interactions, but the discrete nature and coarse temporal resolution of data mean that ephemeral interactions that occur between consecutive GPS locations go undetected. Here, we developed a method to quantify individual and spatial patterns of interaction using continuous-time movement models (CTMMs) fit to GPS tracking data. We first applied CTMMs to infer the full movement trajectories at an arbitrarily fine temporal scale before estimating interactions, thus allowing inference of interactions occurring between observed GPS locations. Our framework then infers indirect interactions—individuals occurring at the same location, but at different times—while allowing the identification of indirect interactions to vary with ecological context based on CTMM outputs. We assessed the performance of our new method using simulations and illustrated its implementation by deriving disease-relevant interaction networks for two behaviorally differentiated species, wild pigs (Sus scrofa) that can host African Swine Fever and mule deer (Odocoileus hemionus) that can host chronic wasting disease. Simulations showed that interactions derived from observed GPS data can be substantially underestimated when temporal resolution of movement data exceeds 30-min intervals. Empirical application suggested that underestimation occurred in both interaction rates and their spatial distributions. CTMM-Interaction method, which can introduce uncertainties, recovered majority of true interactions. Our method leverages advances in movement ecology to quantify fine-scale spatiotemporal interactions between individuals from lower temporal resolution GPS data. It can be leveraged to infer dynamic social networks, transmission potential in disease systems, consumer–resource interactions, information sharing, and beyond. The method also sets the stage for future predictive models linking observed spatiotemporal interaction patterns to environmental drivers

Defining an epidemiological landscape that connects movement ecology to pathogen transmission and pace-of-life

Pathogen transmission depends on host density, mobility and contact. These components emerge from host and pathogen movements that themselves arise through interactions with the surrounding environment. The environment, the emergent host and pathogen movements, and the subsequent patterns of density, mobility and contact form an ‘epidemiological landscape’ connecting the environment to specific locations where transmissions occur. Conventionally, the epidemiological landscape has been described in terms of the geographical coordinates where hosts or pathogens are located. We advocate for an alternative approach that relates those locations to attributes of the local environment. Environmental descriptions can strengthen epidemiological forecasts by allowing for predictions even when local geographical data are not available. Environmental predictions are more accessible than ever thanks to new tools from movement ecology, and we introduce a ‘movement-pathogen pace of life’ heuristic to help identify aspects of movement that have the most influence on spatial epidemiology. By linking pathogen transmission directly to the environment, the epidemiological landscape offers an efficient path for using environmental information to inform models describing when and where transmission will occur

Institutionalizing the management of sick young infants: Kenya’s experience in revising national guidelines on integrated management of newborn and childhood illnesses

Introduction: In 2015, the World Health Organization (WHO) developed guidelines for the management of sick young infants (SYIs) with possible serious bacterial infection (PSBI) where referral is not feasible. The Ponya Mtoto project was designed as an implementation research project to demonstrate how to adopt the WHO PSBI guidelines in the Kenyan context. Ponya Mtoto Project Description: Between October 2017 and June 2021, Ponya Mtoto was implemented in 4 Kenyan counties with higher infant and newborn mortality rates than the national mean. A total of 48 health facilities stratified by level of services were selected as study sites. Implementation Approach: The following activities were done to institutionalize the management of SYIs with PSBI where referral is not feasible in Kenya’s health system: (1) participating in a cocreation workshop and development of a theory of change; (2) revising the national integrated management of newborn and childhood illnesses guidelines to incorporate the management of PSBI where referral is not feasible; (3) improving availability of essential commodities; (4) strengthening provider confidence in the management of SYIs; (5) strengthening awareness about PSBI services for SYIs at the community level; and (6) harmonizing the national integrated management of newborn and childhood illnesses guidelines to address discrepancies in the content on the management of PSBI. In addition, the project focused on strengthening quality of care for SYIs and using implementation research to track progress in achieving project targets and outcomes. Conclusion: Using an implementation research approach to introduce new WHO guidelines on PSBI where referral is not feasible into Kenya’s health care service was critical to fostering engagement of a diverse range of stakeholders, monitoring provider skills and confidence-building, strengthening provision of key commodities for managing SYIs with PSBI, and sustaining community-facility linkages

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Post-print: Sleep fragmentation hypersensitizes healthy young women to deep and superficial experimental pain. DOI: 10.1016/j.jpain.2017.02.436

<b>Post-print copy of: </b>Iacovides S, George K, Kamerman P, Baker FC. Sleep fragmentation hypersensitizes healthy young women to deep and superficial experimental pain. <i>Journal of Pain</i> 18: 844-854, 2017. DOI: <a href="http://dx.doi.org/10.1016/j.jpain.2017.02.436">10.1016/j.jpain.2017.02.436</a>, PMID: 2830065<div><br><div><div><div><div><b>Dataset and analysis scripts:</b> <a href="https://doi.org/10.6084/m9.figshare.4539880" target="_blank">10.6084/m9.figshare.4539880</a></div><div><div><br></div><div><b>Abstract: </b>The effect of sleep deprivation on pain sensitivity has typically been studied using total and partial sleep deprivation protocols. These protocols do not mimic the fragmented pattern of sleep disruption usually observed in individuals with clinical pain conditions. Therefore, we investigated the effect of sleep fragmentation on pain perception (deep pain: forearm muscle ischaemia, and superficial pain: graded pin-pricks applied to the skin) in 11 healthy young women following two consecutive nights of sleep fragmentation, compared with a normal night of sleep. Compared to normal sleep, sleep fragmentation resulted in significantly poorer sleep quality, morning vigilance, and global mood. Pin-prick threshold decreased significantly (increased sensitivity), as did habituation to ischaemic muscle pain (increased sensitivity), over the course of the two nights of sleep fragmentation compared to the night of normal sleep. Sleep fragmentation did not increase the maximum pain intensity reported during muscle ischaemia (no increase in gain), and nor did it increase the number of spontaneous pains reported by participants. Our data show that sleep fragmentation in healthy, young, pain-free women increases pain sensitivity in superficial and deep tissues, indicating a role for sleep disruption, through sleep fragmentation, in modulating pain perception.</div></div></div><div><b><br></b></div><div><b>Perspectives</b></div><div>Our findings that pain-free, young women develop hyperalgesia to superficial and deep-muscle pain after short-term sleep disruption highlight the need for effective sleep management strategies in patients with pain. Findings also suggest the possibility that short-term sleep disruption associated with recurrent acute pain could contribute to increased risk for future chronic pain condition. <b><br></b></div></div></div><div><br></div></div

Factors influencing community-facility linkage for case management of possible serious bacterial infection (PSBI) among young infants in Kenya

Despite evidence showing the feasibility and acceptability of implementing the World Health Organization’s guidelines on managing possible serious bacterial infections (PSBI) in Kenya, the initial implementation revealed sub-optimal community-facility referrals and follow-up of PSBI cases. This study explores facilitators and barriers of community-facility linkages in implementing PSBI guidelines in Busia and Migori counties, Kenya. We used an exploratory qualitative study design drawing on endline evaluation data from the ‘COVID-19: Mitigating Neonatal Mortality’ project collected between June and July 2022. Data include case narratives with caregivers of SYIs 0-59 days old (18), focus group discussions with community health volunteers (CHVs) (6), and in-depth interviews with facility-based providers (18). Data were analysed using an inductive thematic analysis framework. Between August 2021 and July 2022, CHVs assessed 10 187 newborns, with 1176 (12%) identified with PSBI danger signs and referred to the nearest facility, of which 820 (70%) accepted referral. Analysis revealed several factors facilitating community-facility linkage for PSBI treatment, including CHVs’ relationship with community members and facilities, availability of a CHV desk and tools, use of mobile app, training, and supportive supervision. However, challenges such as health system-related factors (inadequate providers, stockout of essential commodities and supplies, and lack of transport/ambulance), and individual-related factors (caregivers’ refusal to take referrals) hindered community-facility linkage. Addressing common barriers and fostering positive relationships between community health workers and facilities can enhance acceptance and access of PSBI services at the community level. Combining community health workers’ efforts with a mobile digital strategy can improve the efficiency of the identification, referral, and tracking of PSBI cases in the community and facilitate linkage with primary healthcare facilities

Preprint—Family and provider perceptions of quality of care in the management of sick young infants in primary health care settings in four counties of Kenya

This article is a preprint and has not been peer-reviewed. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice. ---------------------- Background: Understanding the perceptions of quality of care given to sick young infants in primary health care settings is key for developing strategies for effective uptake and utilization of PSBI guidelines. The purpose of this study is to assess families\u27 and providers\u27 perceptions of care given to sick young infants at primary healthcare facilities in four diverse counties in Kenya. Methods: A cross-sectional qualitative design involving in-depth interviews (23) and focus group discussions (25) with very young (15-18 years), young (19-24 years) and older (25-45 years) caregivers of young infants 0-59 days; and key informant interviews with community- and facility-based frontline health providers (14) in primary health care facilities. Qualitative data were captured using audio tapes and field notes, transcribed, translated, and exported into QSR NVivo 12 for analysis. A thematic framework approach was adopted to classify and analyze data. Results: Perceived care given to SYIs was described around six domains of WHO\u27s framework for the quality of maternal and newborn health care: evidence-based practices for routine and emergency care; functional referral systems; effective communication; respect and preservation of dignity; availability of competent, motivated human resources; and availability of physical resources. Views of caregivers and providers regarding SYIs care at PHCs were similar across the four sites. Main hindrance to SYI care includes stockout of essential drugs, limited infrastructure, lack of functional referral system, inadequate providers which led to delays in receiving treatment, inadequate provider skills and poor provider attitudes. Despite these challenges, motivation and teamwork of health providers were key tenets in care provision. Conclusion: The findings underscore the need to prioritize improving quality of SYIs services at PHCs by building capacity of providers through training, ensuring continuous supply of essential medicines and equipment, improving infrastructure including referral

Measuring implementation outcomes in the context of scaling up possible serious bacterial infection guidelines: Implications for measurement and programs

Background: Reducing the burden of neonatal sepsis requires timely identification and initiation of suitable antibiotic treatment in primary health care (PHC) settings. Countries are encouraged to adopt simplified antibiotic regimens at the PHC level for treating sick young infants (SYI) with signs of possible serious bacterial infection (PSBI). As countries implement PSBI guidelines, more lessons on effective implementation strategies and outcome measurements are needed. We document pragmatic approaches used to design, measure and report implementation strategies and outcomes while adopting PSBI guidelines in Kenya. Methods: We designed implementation research using longitudinal mixed methods embedded in a continuous regular systematic learning and adoption of evidence in the PHC context. We synthesized formative data to co-create with stakeholders, implementation strategies to incorporate PSBI guidelines into routine service delivery for SYIs. This was followed by quarterly monitoring for learning and feedback on the effect of implementation strategies, documented lessons learned and tracked implementation outcomes. We collected endline data to measure the overall effect on service level outcomes. Results: Our findings show that characterizing implementation strategies and linking them with implementation outcomes, helps illustrate the pathway between the implementation process and outcomes. Although we have demonstrated that it is feasible to implement PSBI in PHC, effective investment in continuous capacity strengthening of providers through blended approaches, efficient use of available human resources, and improving the efficiency of service areas for managing SYIs optimizes timely identification and management of SYI. Sustained provision of commodities for management of SYI facilitates increased uptake of services. Strengthening facility-community linkages supports adherence to scheduled visits. Enhancing the caregiver’s preparedness during postnatal contacts in the community or facility will facilitate the effective completion of treatment. Conclusion: Careful design, and definition of terms related to the measurement of implementation outcomes and strategies enable ease of interpretation of findings. Using the taxonomy of implementation outcomes help frame the measurement process and provides empirical evidence in a structured way to demonstrate causal relationships between implementation strategies and outcomes. Using this approach, we have illustrated that the implementation of simplified antibiotic regimens for treating SYIs with PSBI in PHC settings is feasible in Kenya