Understanding the Importance of Asymptomatic and Low- Density Infections for Malaria Elimination

In recent years, the use of more sensitive diagnostic techniques has demonstrated a significant number of malaria infections at densities beneath the limit of detection of conventional microscopy and rapid diagnostic tests (RDT). These low-density infections are almost always asymptomatic, found in all endemic settings, including those nearing elimination, and in all ages of the population. They typically account for a high proportion of all infections and since they have also been shown to be infectious to mosquitoes, low-density infections are thought to be important contributors to maintaining malaria transmission. However, there is currently no direct evidence that specifically targeting this low-density parasite reservoir will hasten progress towards elimination. In this chapter we review the data to date and identify knowledge gaps. We present potential scenarios for the causes of low-density infections, if and how these might drive transmission, and the likely impact of specifically targeting them

Adapting the Body Appreciation Scale-2 for Children: A psychometric analysis of the BAS-2C

© 2017 Positive body image among adults is related to numerous indicators of well-being. However, no research has explored body appreciation among children. To facilitate our understanding of children's positive body image, the current study adapts and validates the Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015a) for use with children. Three hundred and forty-four children (54.4% girls) aged 9–11 completed the adapted Body Appreciation Scale-2 for Children (BAS-2C) alongside measures of body esteem, media influence, body surveillance, mood, and dieting. A sub-sample of 154 participants (62.3% girls) completed the questionnaire 6-weeks later to examine stability (test-retest) reliability. The BAS-2C displayed a unidimensional factor structure and evidence of internal consistency, test-retest reliability, and construct, criterion-related, and incremental validity. Additionally, the results suggest adaptive properties of body appreciation for body-related and emotional well-being among children. The BAS-2C could serve as an essential component within research to understand and estimate children's positive body image

Evaluating the impact of a brief yoga intervention on preadolescents’ body image and mood

Yoga is an embodying activity that promotes body awareness, body connection, body responsiveness, and appreciation of body functionality, and it therefore may be a beneficial school-based intervention for children’s body image. The present study examined the impact of a 4-week yoga intervention on pre-adolescent girls’ and boys’ body image (body appreciation, body esteem, and body surveillance) and mood (positive and negative affect) 1-week post-intervention and at 6-week follow-up. British children (N = 344; 54.4% female) aged 9-11 years were recruited from four schools, two of which were randomly assigned to the yoga intervention and two to a physical education control condition. Unexpectedly, both groups increased body appreciation, body esteem, and positive mood, and decreased body surveillance and negative affect from baseline to post-intervention and/or follow-up. Children in the yoga intervention evaluated the sessions very favourably; the majority desired to participate in more lessons. Potential explanations for these findings are discussed

Quantifying Plasmodium falciparum infections clustering within households to inform household-based intervention strategies for malaria control programs: An observational study and meta-analysis from 41 malaria-endemic countries.

BACKGROUND: Reactive malaria strategies are predicated on the assumption that individuals infected with malaria are clustered within households or neighbourhoods. Despite the widespread programmatic implementation of reactive strategies, little empirical evidence exists as to whether such strategies are appropriate and, if so, how they should be most effectively implemented. METHODS AND FINDINGS: We collated 2 different datasets to assess clustering of malaria infections within households: (i) demographic health survey (DHS) data, integrating household information and patent malaria infection, recent fever, and recent treatment status in children; and (ii) data from cross-sectional and reactive detection studies containing information on the household and malaria infection status (patent and subpatent) of all-aged individuals. Both datasets were used to assess the odds of infections clustering within index households, where index households were defined based on whether they contained infections detectable through one of 3 programmatic strategies: (a) Reactive Case Detection (RACD) classifed by confirmed clinical cases, (b) Mass Screen and Treat (MSAT) classifed by febrile, symptomatic infections, and (c) Mass Test and Treat (MTAT) classifed by infections detectable using routine diagnostics. Data included 59,050 infections in 208,140 children under 7 years old (median age = 2 years, minimum = 2, maximum = 7) by microscopy/rapid diagnostic test (RDT) from 57 DHSs conducted between November 2006 and December 2018 from 23 African countries. Data representing 11,349 infections across all ages (median age = 22 years, minimum = 0.5, maximum = 100) detected by molecular tools in 132,590 individuals in 43 studies published between April 2006 and May 2019 in 20 African, American, Asian, and Middle Eastern countries were obtained from the published literature. Extensive clustering was observed-overall, there was a 20.40 greater (95% credible interval [CrI] 0.35-20.45; P < 0.001) odds of patent infections (according to the DHS data) and 5.13 greater odds (95% CI 3.85-6.84; P < 0.001) of molecularly detected infections (from the published literature) detected within households in which a programmatically detectable infection resides. The strongest degree of clustering identified by polymerase chain reaction (PCR)/ loop mediated isothermal amplification (LAMP) was observed using the MTAT strategy (odds ratio [OR] = 6.79, 95% CI 4.42-10.43) but was not significantly different when compared to MSAT (OR = 5.2, 95% CI 3.22-8.37; P-difference = 0.883) and RACD (OR = 4.08, 95% CI 2.55-6.53; P-difference = 0.29). Across both datasets, clustering became more prominent when transmission was low. However, limitations to our analysis include not accounting for any malaria control interventions in place, malaria seasonality, or the likely heterogeneity of transmission within study sites. Clustering may thus have been underestimated. CONCLUSIONS: In areas where malaria transmission is peri-domestic, there are programmatic options for identifying households where residual infections are likely to be found. Combining these detection strategies with presumptively treating residents of index households over a sustained time period could contribute to malaria elimination efforts

Telepharmacy and Access to Pharmaceutical Services in Rural Areas

Access to pharmaceutical services in rural areas has been affected by a national shortage of pharmacists. Telepharmacy, a subspecialty of telemedicine, has involved the utilization of telecommunications to deliver pharmaceutical services to consumers located at a distance. The number of telepharmacy programs in the United States and worldwide has been progressively increasing. The purpose of this research project was to examine the effect of the utilization of telepharmacy on rural hospitals’ access to pharmaceutical services. The methodology of this qualitative study was a literature review. Four electronic databases were employed to retrieve peer-reviewed journal articles, and three websites were accessed for pertinent information. Sixy-six articles were utilized as references. The findings demonstrate that telepharmacy networks have provided some benefits through which pharmaceutical access to rural areas has been enhanced. Networks have hastened medication order entry and order processing, increased on-call consultations and after-hours orders, and reconciled medications. Various states have reported promising results after implementing these networks. Moreover, networks have also permitted thorough checking of orders in both urban and rural pharmacies, thereby limiting medication errors. Overall, telepharmacy has had a positive effect on access to pharmaceutical services in rural areas. Such networks could diminish the problem of rural pharmacist understaffing, especially after hours and during vacations. Telepharmacy could also aid in reducing medication errors, which have increased as a result of the inability to recruit and retain pharmacists in rural areas. Telepharmacy should be utilized as a tool to maintain the pharmacist-consumer relationship

Screening for an ivermectin slow-release formulation suitable for malaria vector control

BACKGROUND: The prospect of eliminating malaria is challenged by emerging insecticide resistance and vectors with outdoor and/or crepuscular activity. Ivermectin can simultaneously tackle these issues by killing mosquitoes feeding on treated animals and humans. A single oral dose, however, confers only short-lived mosquitocidal plasma levels. METHODS: Three different slow-release formulations of ivermectin were screened for their capacity to sustain mosquito-killing levels of ivermectin for months. Thirty rabbits received a dose of one, two or three silicone implants containing different proportions of ivermectin, deoxycholate and sucrose. Animals were checked for toxicity and ivermectin was quantified periodically in blood. Potential impact of corresponding long-lasting formulation was mathematically modelled. RESULTS: All combinations of formulation and dose released ivermectin for more than 12 weeks; four combinations sustained plasma levels capable of killing 50% of Anopheles gambiae feeding on a treated subject for up to 24 weeks. No major adverse effects attributable to the drug were found. Modelling predicts a 98% reduction in infectious vector density by using an ivermectin formulation with a 12-week duration. CONCLUSIONS: These results indicate that relatively stable mosquitocidal plasma levels of ivermectin can be safely sustained in rabbits for up to six months using a silicone-based subcutaneous formulation. Modifying the formulation of ivermectin promises to be a suitable strategy for malaria vector control

Who's most at risk of poor body image? Identifying subgroups of adolescent social media users over the course of a year

Types and stability of appearance-related social media use patterns remain under-explored despite established links between social media use and wellbeing. This study aimed to identify subgroups of social media users, and explore whether subgroup membership was stable over time and associated with body image-related outcomes. Adolescents (N = 766; Mage = 12.76, SD = 0.73; 49.40% female) completed four surveys across 1-year, reporting several social media use indices, body dissatisfaction, dietary restraint, and strategies to increase muscle. Latent profile analyses identified two subgroups (moderate and high users), that remained reasonably stable over time. The high subgroup exhibited poorer body image at baseline, though differences seemed to dissipate somewhat over 1-year. Examination of subgroup transition over time showed more rapid increases in poor body image outcomes among social media increasers and more rapid declines for reducers. Prevention programs which aim to reduce high levels of social media use among children, young adolescents, and high-risk individuals (i.e., appearance-focused users) appear warranted

Targeting cattle for malaria elimination: marked reduction of Anopheles arabiensis survival for over six months using a slow-release ivermectin implant formulation

BACKGROUND: Mosquitoes that feed on animals can survive and mediate residual transmission of malaria even after most humans have been protected with insecticidal bednets or indoor residual sprays. Ivermectin is a widely-used drug for treating parasites of humans and animals that is also insecticidal, killing mosquitoes that feed on treated subjects. Mass administration of ivermectin to livestock could be particularly useful for tackling residual malaria transmission by zoophagic vectors that evade human-centred approaches. Ivermectin comes from a different chemical class to active ingredients currently used to treat bednets or spray houses, so it also has potential for mitigating against emergence of insecticide resistance. However, the duration of insecticidal activity obtained with ivermectin is critical to its effectiveness and affordability. RESULTS: A slow-release formulation for ivermectin was implanted into cattle, causing 40 weeks of increased mortality among Anopheles arabiensis that fed on them. For this zoophagic vector of residual malaria transmission across much of Africa, the proportion surviving three days after feeding (typical mean duration of a gonotrophic cycle in field populations) was approximately halved for 25 weeks. CONCLUSIONS: This implantable ivermectin formulation delivers stable and sustained insecticidal activity for approximately 6 months. Residual malaria transmission by zoophagic vectors could be suppressed by targeting livestock with this long-lasting formulation, which would be impractical or unacceptable for mass treatment of human populations

Community Treatment Orders and mental health social work : issues for policy and practice in the UK and Ireland

This comparative scoping review charts and compares current and emerging issues for mental health social workers involved in the use of compulsory mental health legislation in the UK and Ireland. It acknowledges a dearth of research evidence in this key area of social work practice and an urgent need to critically examine the use of such compulsory intervention given the significant human rights implications of forced detention and medical treatment. A case study approach is used in the paper with specific focus on the role that mental health social workers play in the delivery of community based compulsory treatment orders (CTOs) in three UK jurisdictions (England, Wales and Scotland) and two where, at present they are not used, nor are planned to be used (Northern Ireland and the Republic of Ireland). The paper starts by offering an historical overview of the mandated and other roles of mental health social workers in the UK and Ireland with particular attention to the shifts in policy and law created by the processes of devolution that have occurred in the last few decades. This discussion draws out distinctions between jurisdictions, but notes the common policy and legal imperatives that involve social workers in decision-making in relation to CTOs, and the use of compulsory measures more broadly. Analysis is provided in terms of comparative themes, including the rationale for CTOs, legal thresholds, service user rights and trends in the use of CTOs and equivalent statutory measures. Attention is paid to the roles social workers undertake, both in terms of formal decision-making regarding applications for CTOs and post-hoc care and monitoring. This is compared with the social work role in the two jurisdictions without CTOs: Northern Ireland and the Republic of Ireland. A discussion then takes place about the ethical and practice dilemmas that social workers experience in these contexts, including inherent tensions between the potentially coercive nature of CTOs and social work’s espoused commitment to human rights and social justice, set against the paradigmatic shift in thinking about the legality of compulsion reflected in the United Nations Convention on the Rights of Persons with Disabilities. The paper considers the extent to which social workers can bring a social perspective to counter prevailing medical discourses in framing and responding to mental distress in statutory settings and to uphold citizens’ broader social and cultural needs in the context of welfare austerity. It concludes with an appeal for future critical analyses of the mental health role when such compulsory laws are being applied