Intervention effects maintenance: 6-month randomized controlled trial follow-up of standard and reflexive pelvic floor muscle training

BACKGROUND To date, the focus of pelvic floor muscle training for women suffering from stress urinary incontinence has been on voluntary contractions although involuntary pelvic floor muscle contractions are crucial to guarantee continence in high-impact situations typically triggering this condition. The authors developed 2 pelvic floor muscle home training programs, one including standard voluntary pelvic floor muscle training and one including involuntary reflexive pelvic floor muscle training. OBJECTIVE This study aimed to test 2 pelvic floor muscle home training programs regarding maintenance of effects of a previous 16-week intervention in terms of stress urinary incontinence symptoms (International Consultation on Incontinence Modular Questionnaire—Urinary Incontinence short form, modified 20-minute pad test), impact on quality of life (Lower Urinary Tract Symptoms Quality of Life module), and digitally assessed pelvic floor muscle strength. STUDY DESIGN This trial was a continuation of a previously published triple-blind prospective randomized controlled trial with a 6-month evaluation endpoint with 2 intervention groups (experimental group with involuntary reflexive home pelvic floor muscle training and control group with standard voluntary home pelvic floor muscle training). RESULTS From the originally included 96 randomized and allocated participants (experimental group=46, control group=46), 33 control and 27 experimental participants completed the 6-month follow-up. From post–16-week physiotherapy intervention to 6-month follow-up (home pelvic floor muscle training), there were statistically significant improvements in pelvic floor muscle strength (control and experimental group), and no difference in the International Consultation on Incontinence Modular Questionnaire—Urinary Incontinence short form and pad test, or the Lower Urinary Tract Symptoms Quality of Life module Part B (control and experimental group) and Part A (control group). However, there was a statistically significant improvement in the Lower Urinary Tract Symptoms Quality of Life module Part A (experimental group). At no point in time (pre, post, follow-up) was there any statistically significant difference between the groups. CONCLUSION Both groups could maintain their intervention training effects. This trial investigated involuntary reflexive pelvic floor muscle training alone, which proved to be an effective alternative to standard voluntary pelvic floor muscle training for maintenance of training effects among women suffering from stress urinary incontinence

Boundary-spanning: reflections on the practices and principles of Global Health.

As Global Health evolves, not merely as a metaphor for international collaboration, but as a distinct field of practice, it warrants greater consideration of how it is practiced, by whom, and for what goals. We believe that, to become more relevant for the health systems and communities that are their intended beneficiaries, Global Health practices must actively span and disrupt boundaries of geography, geopolitics and constituency, some of which are rooted in imbalances of power and resources. In this process, fostering cross-country learning networks and communities of practice, and building local and national institutions with a global outlook in low and middle-income countries, are critically important. Crucially, boundary-spanning practices in Global Health require a mindset of inclusiveness, awareness of and respect for different coexisting realities

Strengthening post-graduate educational capacity for health policy and systems research and analysis: the strategy of the Consortium for Health Policy and Systems Analysis in Africa.

BACKGROUND: The last 5-10 years have seen significant international momentum build around the field of health policy and systems research and analysis (HPSR + A). Strengthening post-graduate teaching is seen as central to the further development of this field in low- and middle-income countries. However, thus far, there has been little reflection on and documentation of what is taught in this field, how teaching is carried out, educators' challenges and what future teaching might look like. METHODS: Contributing to such reflection and documentation, this paper reports on a situation analysis and inventory of HPSR + A post-graduate teaching conducted among the 11 African and European partners of the Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA), a capacity development collaboration. A first questionnaire completed by the partners collected information on organisational teaching contexts, while a second collected information on 104 individual courses (more in-depth information was subsequently collected on 17 of the courses). The questionnaires yielded a mix of qualitative and quantitative data, which were analysed through counts, cross-tabulations, and the inductive grouping of material into themes. In addition, this paper draws information from internal reports on CHEPSAA's activities, as well as its external evaluation. RESULTS: The analysis highlighted the fluid boundaries of HPSR + A and the range and variability of the courses addressing the field, the important, though not exclusive, role of schools of public health in teaching relevant material, large variations in the time investments required to complete courses, the diversity of student target audiences, the limited availability of distance and non-classroom learning activities, and the continued importance of old-fashioned teaching styles and activities. CONCLUSIONS: This paper argues that in order to improve post-graduate teaching and continue to build the field of HPSR + A, key questions need to be addressed around educational practice issues such as the time allocated for HPSR + A courses, teaching activities, and assessments, whether HPSR + A should be taught as a cross-cutting theme in post-graduate degrees or an area of specialisation, and the organisation of teaching given the multi-disciplinary nature of the field. It ends by describing some of CHEPSAA's key post-graduate teaching development activities and how these activities have addressed the key questions

Health policy and systems research capacity development to support maternal, new-born, child and adolescent health in West and Central Africa

Objectives: To examine how and why a South-South capacity development and networking program for leadership, research, practice and advocacy on maternal new-born, child and adolescent health and health policy and systems strengthening in West Africa and Cameroon worked and identify lessons for low- and middle-income countries.Design: Single qualitative case study drawing on data from document review, observations, key informant interviews and a deliberative workshop. Ethics approval for primary data collection was obtained from the Ghana Health Service Ethical Review Committee (GHS-ERC 012/10/18).Setting: West Africa and CameroonParticipants: Researchers, policy and programme managers and frontline health workersInterventions: Networking and capacity developmentResults: The programme made good progress in implementing many but not all planned capacity development and networking activities. The opportunity to network with other organisations and individuals and across countries, disciplines, and languages as well as to learn, to develop skills, and obtain mentorship support, were considered valu-able benefits of the partnership. Human and financial resource constraints meant that not all planned interventions could be implemented.Conclusions: Lessons for health policy and systems research capacity building in LMIC include the potential of South-South partnerships, the need for dedicated resources, the potential of Sub-regional health organizations to sup-port capacity building and recognition that each effort builds on preceding efforts of others, and that it is important to explore and understand where the energy and momentum for change lies

Strategic leadership capacity building for Sub-Saharan African health systems and public health governance: a multi-country assessment of essential competencies and optimal design for a Pan African DrPH

Leadership capacity needs development and nurturing at all levels for strong health systems governance and improved outcomes. The Doctor of Public Health (DrPH) is a professional, interdisciplinary terminal degree focused on strategic leadership capacity building. The concept is not new and there are several programmes globally–but none within Africa, despite its urgent need for strong strategic leadership in health. To address this gap, a consortium of institutions in Sub-Saharan Africa, UK and North America have embarked on a collaboration to develop and implement a pan-African DrPH with support from the Rockefeller Foundation. This paper presents findings of research to verify relevance, identify competencies and support programme design and customization. A mixed methods cross sectional multi-country study was conducted in Ghana, South Africa and Uganda. Data collection involved a non-exhaustive desk review, 34 key informant (KI) interviews with past and present health sector leaders and a questionnaire with closed and open ended items administered to 271 potential DrPH trainees. Most study participants saw the concept of a pan-African DrPH as relevant and timely. Strategic leadership competencies identified by KI included providing vision and inspiration for the organization, core personal values and character qualities such as integrity and trustworthiness, skills in adapting to situations and context and creating and maintaining effective change and systems. There was consensus that programme design should emphasize learning by doing and application of theory to professional practice. Short residential periods for peer-to-peer and peer-to-facilitator engagement and learning, interspaced with facilitated workplace based learning, including coaching and mentoring, was the preferred model for programme implementation. The introduction of a pan-African DrPH with a focus on strategic leadership is relevant and timely. Core competencies, optimal design and customization for the sub-Saharan African context has broad consensus in the study setting

Community based weighing of newborns and use of mobile phones by village elders in rural settings in Kenya: a decentralised approach to health care provision

<p>Abstract</p> <p>Background</p> <p>Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children's Health study area in Kenya revealed that up to 70% of newborns did not have exact weights measured and recorded by the end of the first week of life; nearly all of these infants were born outside health facilities.</p> <p>Methods</p> <p>To more completely obtain accurate birth weights for all infants, regardless of delivery site, village elders were engaged to assist in case finding for pregnancies and births. All elders were provided with weighing scales and mobile phones as tools to assist in subject enrollment and data recording. Subjects were instructed to bring the newborn infant to the home of the elder as soon as possible after birth for weight measurement.</p> <p>The proportion of pregnancies identified before delivery and the proportion of births with weights measured were compared before and after provision of weighing scales and mobile phones to village elders. Primary outcomes were the percent of infants with a measured birth weight (recorded within 7 days of birth) and the percent of women enrolled before delivery.</p> <p>Results</p> <p>The recorded birth weight increased from 43 ± 5.7% to 97 ± 1.1. The birth weight distributions between infants born and weighed in a health facility and those born at home and weighed by village elders were similar. In addition, a significant increase in the percent of subjects enrolled before delivery was found.</p> <p>Conclusions</p> <p>Pregnancy case finding and acquisition of birth weight information can be successfully shifted to the community level.</p

Dolls/puppets as soulmates – biographical traces of dolls/puppets in art, literature, work and performance

https://dedo.ub.uni-siegen.deDie vorliegende vierte Ausgabe der Zeitschrift denkste: puppe / just a bit of: doll (de:do), ein multidisziplinäres Online-Journal für Mensch-Puppen-Diskurse, greift den Themenschwerpunkt Puppen als Seelenverwandte – biographische Spuren von Puppen in Kunst, Literatur, Werk und Darstellung auf. Es geht um die Frage nach Wirkungen früher Puppenerfahrungen in der späteren künstlerischen Arbeit und damit nach den möglichen (biographischen) Wurzeln und Zusammenhängen von Puppenmotiv und Puppen-Narrativen im künstlerisch-literarischen Werk. Puppenbezüge in Werk- und Schaffensprozessen können frühe Erfahrungen biographischer Brüche und Verletzungen transformieren bzw. sie künstlerisch produktiv integrieren, sie können aber auch Ausdruck für Kontinuität und Intensivierung früher Prägungen und Vorlieben sein. In den vorliegenden Beiträgen geht es um puppenbezogene künstlerische Ausdrucksformen, die als Beiträge hier formal unterschiedlich aufbereitet werden: als wissenschaftsbasierter Text, Selbstbericht, Miszelle, Rezension, Interview und: Kunstwerk. Untersucht und thematisiert werden Puppen-Sammlungen, die Herstellung besonderer Puppen, literarische Puppentexte, Inszenierungen und Bilder. Außerdem wurden weitere Beiträge einbezogen, die Puppen als Varianten „künstlicher Menschen“ in unterschiedlichsten Themenbezügen behandeln. In vielen Beiträgen deutet sich an, dass die Affinität zum „Phänomen Puppe“ in seinen verschiedenen künstlerischen Umsetzungsformen auf biographisch geprägte Spuren verweist: als Ausdrucks- und Darstellungsmittel steht die Puppe somit auch für etwas Besonderes der Menschen, die sich künstlerisch auf sie beziehen und mit ihr interagieren und „spielen“.This fourth issue of denkste: puppe / just a bit of: doll (de:do), a multidisciplinary online journal for human-doll discourses, takes up the thematic focus on dolls/puppets as soulmates – biographical traces of dolls/puppets in art, literature, work and performance. It is about the impact of early doll experiences in later artistic work and thus about the possible (biographical) roots and connections of doll motifs and doll narratives in artistic-literary work. Doll/puppet references in work and creative processes can transform early experiences of biographical breaks and harm or integrate them in an artistically productive way, but they can also be an expression of continuity and intensification of early experience and preferences. The present contributions deal with doll/puppet-related artistic forms of expression, which are formally presented in different ways: as science-based text, self-report, miscellaneous, review, interview and: work of art. Doll/puppet collections, the making of particular puppets, literary puppet texts, performances and images are examined and addressed. In addition, further contributions were included, which deal with dolls as variants of "artificial humans" in the most diverse thematic contexts. Most of the contributions indicate that the affinity to the “phenomenon of the doll” in its various artistic forms of realization refers to biographically shaped traces: as a means of expression and representation the doll thus also stands for something special about the human beings who refer to it artistically and interact and "play" with it

Adhiron: a stable and versatile peptide display scaffold for molecular recognition applications

We have designed a novel non-antibody scaffold protein, termed Adhiron, based on a phytocystatin consensus sequence. The Adhiron scaffold shows high thermal stability (Tm ca. 101°C), and is expressed well in Escherichia coli. We have determined the X-ray crystal structure of the Adhiron scaffold to 1.75 Å resolution revealing a compact cystatin-like fold. We have constructed a phage-display library in this scaffold by insertion of two variable peptide regions. The library is of high quality and complexity comprising 1.3 × 10(10) clones. To demonstrate library efficacy, we screened against the yeast Small Ubiquitin-like Modifier (SUMO). In selected clones, variable region 1 often contained sequences homologous to the known SUMO interactive motif (V/I-X-V/I-V/I). Four Adhirons were further characterised and displayed low nanomolar affinities and high specificity for yeast SUMO with essentially no cross-reactivity to human SUMO protein isoforms. We have identified binders against >100 target molecules to date including as examples, a fibroblast growth factor (FGF1), platelet endothelial cell adhesion molecule (PECAM-1; CD31), the SH2 domain Grb2 and a 12-aa peptide. Adhirons are highly stable and well expressed allowing highly specific binding reagents to be selected for use in molecular recognition applications