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Background: Malnutrition has various adverse effects in children. This study aimed to determine risk factors for malnutrition among hospitalised children, changes in nutritional status at admission and discharge and effects of use of systematic anthropometric measurement in identification of malnutrition. Methods: We enrolled 426 children, aged between 6 months and 15 years, admitted to Siddhi Memorial Hospital, Bhaktapur, Nepal, from November 2016 to June 2017. Anthropometric measurements were performed at the time of admission and discharge. Risk factors were assessed by multivariable logistic regression models. Results: Median age of children was 26 months (IQR: 13–49), and males were 58.7%. The prevalence of wasting was 9.2% (39/426) at admission and 8.5% (36/426) at discharge. Risk factors associated with wasting at admission were ethnic minority (aOR: 3.6, 95% CI 1.2–10.8), diarrhoeal diseases (aOR = 4.0; 95% CI 1.3–11.8), respiratory diseases (aOR: 3.4, 95% CI 1.4–8.1) and earthquake damage to house (aOR = 2.6; 95% CI 1.1–6.3). Clinical observation by care providers identified only 2 out of 112 malnutrition cases at admission and 4 out of 119 cases at discharge that were detected by the systematic anthropometric measurement. Conclusions: Ethnic minority, diarrhoeal diseases, respiratory infections and house damage due to the earthquake were risk factors associated with wasting. Systematic anthropometric examination can identify significantly more malnourished children than simple observation of care providers., Tropical Medicine and Health, 50 (1), art. no. 68; 2022

BACKGROUND It is crucial to develop effective and accessible interventions to improve cognitive sequelae in children treated for brain tumours (CTBT), as their impact on functional outcomes is significant. Instructor-led exercise training in a hospital setting is safe, feasible and efficacious to promote cognitive improvements in patients, however, most receive their post-treatment rehabilitative care in the community. eHealth is well positioned to support the delivery of community interventions. OBJECTIVE We aimed to i) develop a website that provides educational resources/tools for health and fitness professionals (HFP) to deliver exercise training to CTBT in the community with the goal of improving cognitive outcomes and ii) assess the website’s usability by community HFP. It was hypothesized that the website would be rated as learnable, clear, satisfactory and efficient to train on and deliver exercise training to CTBT in the community. METHODS A scoping review of academic literature, and publicly and commercially available eHealth resources was conducted. The scoping review determined the state of eHealth resources to support exercise training for CTBT and identify knowledge and resource gaps. Three focus groups were conducted with HFP with expertise serving cancer survivors in hospital (n=5) and community (n=8) settings to identify user needs and preferences. Content analysis identified themes. Gaps identified in the scoping review and themes from focus groups informed content that was integrated into the website build. Usability by community HFP (n=4) was assessed using a questionnaire (multiple choice, Likert-type, and open-ended questions). Descriptive statistics inferred elements of the website deemed sufficiently learnable, clear, satisfactory and efficient, and aspects with issues requiring modification. The mode of each multiple choice and Likert-type response was calculated to determine the value that appeared most often. Open ended responses identified issues. RESULTS The scoping review revealed a lack of eHealth resources to support exercise training to improve cognitive sequelae in CTBT and education for professionals to deliver training. Six themes were identified in the focus groups: instructor experience, instructor training, training on the intervention, venue considerations/suitability, exercise session planning and feedback. HFP reported the website to be sufficiently learnable, clear, satisfactory and efficient. Two minor issues were reported and addressed: a desire for discussion of appropriate language when instructing and correspondence between website activities and visual tools. CONCLUSIONS The development and usability testing of the website marks one of the first eHealth resources to increase accessibility of interventions typically delivered in a hospital setting to improve cognitive sequelae in CTBT. It also provides professionals the necessary education/tools for delivery in the community and provision of exercise intervention designed to improve cognitive outcomes. This website would afford an increase in the number of patients with access to interventions that promote cognitive improvement and ultimately enhance quality of life.

This article discusses insights arising from a Community of Practice (CoP) initiative within a mental health short stay inpatient unit adjacent to a major Emergency Department to explore how COVID-19 has influenced engagement and support of people in mental distress. The present initiative was designed as a collaboration between the University of South Australia and SA Health. Community of Practice (CoP) is combined with a narrative review of current evidence to explain specific nursing care responses within an operating environment of pandemic-induced fear and uncertainty. Meetings discussed the challenges associated with delivering mental health care for people experiencing mental health distress in the COVID-19 context. Applying trauma-informed principles to mental health care delivery was identified to be of relevance in the context of an ongoing pandemic. Humanizing nursing care and increasing people's sense of predictability and safety contributed to therapeutic engagement and support during COVID-19. Factors discussed to mitigate the effects of safety measures include, for example, nuanced verbal and non-verbal engagement of health workers with people in mental distress when wearing personal protective equipment (PPE). We highlight the need to ‘humanise’ nursing and openly communicating that both practitioners and people in distress are navigating special circumstances. The CoP participants additionally acknowledged that the experience of moral distress among frontline health workers needs to be addressed in future policy responses to COVID-19. Person-centred and trauma-informed responses at the point of care might help to mitigate the pandemic short- and long-term effects for both service users and frontline health workers. Refereed/Peer-reviewed

Severe acute malnutrition may lead both concurrently and subsequently to malabsorption and impaired glucose metabolism from pancreatic dysfunction. We conducted a systematic review to investigate the associations of current and prior postnatal wasting malnutrition with pancreatic endocrine and exocrine functions in humans. We searched PubMed, Google Scholar, Web of Science and reference lists of retrieved articles, limited to articles in English published before 1 February 2022. We included sixty-eight articles, mostly cross-sectional or cohort studies from twenty-nine countries including 592 530 participants, of which 325 998 were from a single study. Many were small clinical studies from decades ago and rated poor quality. Exocrine pancreas function, indicated by duodenal fluid or serum enzymes, or faecal elastase, was generally impaired in malnutrition. Insulin production was usually low in malnourished children and adults. Glucose disappearance during oral and intravenous glucose tolerance tests was variable. Upon treatment of malnutrition, most abnormalities improved but frequently not to control levels. Famine survivors studied decades later showed ongoing impaired glucose tolerance with some evidence of sex differences. The similar findings from anorexia nervosa, famine survivors and poverty- or infection-associated malnutrition in low- and middle-income countries (LMIC) lend credence to results being due to malnutrition itself. Research using large, well-documented cohorts and considering sexes separately, is needed to improve prevention and treatment of exocrine and endocrine pancreas abnormalities in LMIC with a high burden of malnutrition and diabetes.

Globalement, la question de l’arrière a été relativement peu mobilisée de manière transversale et transnationale par une historiographie de la Grande Guerre longtemps assez indifférente à cet « autre front ». Si les mobilisations militaires ont été largement étudiées, celles propres aux sociétés civiles européennes traversées par la guerre constituent en revanche encore un champ à la fois très vaste et partiellement défriché : comment, loin du front, dans une Europe déchirée par la guerre, les populations ont-elles réussi à s’adapter à un quotidien complètement bouleversé ? Quelles ont été les formes et les degrés de leurs mobilisations ou de leurs résistances ? C’est à ces questions que le présent ouvrage entend répondre en articulant quatre thématiques principales jusqu’à présent assez peu abordées dans un cadre européen, emboîtant les échelles nationales régionales, départementales voire villageoises. Les aspects économiques sont ainsi essentiels à la compréhension d’un conflit qui s’appuie comme jamais auparavant sur des productions de masse reconfigurant le cadre productif. L’encadrement des individus par les initiatives privées ou étatiques contribue de manière décisive à la mobilisation dans la durée des populations civiles. Par ailleurs, le croisement des expériences rurales et citadines, dans des espaces encore mal connus, met en lumière des acteurs locaux pris entre les pratiques ordinaires et l’extraordinaire du temps de guerre. Enfin, l’étude de la construction et de l’hybridation des identités et des représentations à l’arrière permet une relecture neuve des expériences vécues du conflit.

Clemens Pirquet, ainsi que son épouse Maria, ont été retrouvés morts dans leur appartement viennois le soir du 27 février 1929. La cause de la mort a été rapidement identifiée : suicide par ingestion de phosphate de cyanure. Maria souffrait depuis de longues années d’une santé mentale et physique fragile, dépendant de barbituriques pour se soulager ; au cours des mois précédant le suicide, elle aurait subi une dépression. Il y avait également des problèmes de famille et des difficultés au sei...

The COVID-19 pandemic has disproportionately affected pregnant people by increasing health risks of maternal morbidity and mortality, stillbirth, and preterm birth. Although numerous studies have supported the safety and efficacy of COVID-19 vaccination in pregnancy in preventing or mitigating the risk for these adverse outcomes, many pregnant people remain hesitant. Approximately half of US adults regularly consume news from social media platforms, which are a fertile ground for the spread of vaccine disinformation. The lack of information regarding COVID-19 vaccine safety early in the pandemic fueled vaccine myths targeting the fears of pregnant people about vaccination risks. Saddened by the spike in maternal deaths of unvaccinated individuals during the COVID-19 Delta variant surge in the fall of 2021, we created a social media campaign to promote scientific communication regarding the risks of COVID-19 disease in pregnancy and the benefits of vaccination. We called the campaign "One Vax Two Lives," which refers to the ability of 1 maternal vaccine to benefit the health and lives of both the pregnant individual and their fetus. We present a blueprint of how we leveraged a large, interdisciplinary student workforce to create a social media campaign and research program studying vaccine hesitancy, which can be replicated by other groups. Community engagement and partnerships with key stakeholders, such as the Washington State Department of Health, were essential for amplifying the campaign and providing our team with feedback on content and approach. We present the analytics of our social media advertisements, web articles, and video content that helped inform the iterative design process of the multimedia content. Moving forward, we are launching collaborative research programs to study vaccine hesitancy and inform the development of new social media content designed for pregnant individuals who are: (1) Spanish-speaking Hispanic/Latina/x, (2) Black or Afro-Latinx, and (3) residents of rural communities in the State of Washington. Data from these mixed methods studies will inform new communication campaigns to reach vaccine-hesitant individuals. Finally, we discuss lessons learned and how the most impactful elements of the campaign can be translated to related areas of maternal public health.

We asked whether pharmacological stimulation of endogenous neural precursor cells (NPCs) may promote cognitive recovery and brain repair, focusing on the drug metformin, in parallel rodent and human studies of radiation injury. In the rodent cranial radiation model, we found that metformin enhanced the recovery of NPCs in the dentate gyrus, with sex-dependent effects on neurogenesis and cognition. A pilot double-blind, placebo-controlled crossover trial was conducted (ClinicalTrials.gov, NCT02040376) in survivors of pediatric brain tumors who had been treated with cranial radiation. Safety, feasibility, cognitive tests and MRI measures of white matter and the hippocampus were evaluated as endpoints. Twenty-four participants consented and were randomly assigned to complete 12-week cycles of metformin (A) and placebo (B) in either an AB or BA sequence with a 10-week washout period at crossover. Blood draws were conducted to monitor safety. Feasibility was assessed as recruitment rate, medication adherence and procedural adherence. Linear mixed modeling was used to examine cognitive and MRI outcomes as a function of cycle, sequence and treatment. We found no clinically relevant safety concerns and no serious adverse events associated with metformin. Sequence effects were observed for all cognitive outcomes in our linear mixed models. For the subset of participants with complete data in cycle 1, metformin was associated with better performance than placebo on tests of declarative and working memory. We present evidence that a clinical trial examining the effects of metformin on cognition and brain structure is feasible in long-term survivors of pediatric brain tumors and that metformin is safe to use and tolerable in this population. This pilot trial was not intended to test the efficacy of metformin for cognitive recovery and brain growth, but the preliminary results are encouraging and warrant further investigation in a large multicenter phase 3 trial.

The type of clothing worn, revealing versus concealing, can affect the performance of women on cognitive tasks. This difference in performance may arise because of changes in body awareness that may draw cognitive resources from the goal task. The present study investigated the influence of the style of athletic clothing and body awareness on visual-motor performance in women. Participants (women ages 18-35 years) were randomly assigned to wear tight and revealing (TR group, n = 40) or loose and concealing (LC group, n = 40) athletic clothing. All participants completed the same visual-motor aiming task to assess spatiotemporal measures of motor performance. In addition to the clothing, participants were primed to be conscious of their bodies via measurements of height, weight, and waist circumference; photographs taken of their bodies; a computerized body-size distortion task; and a mirror in the testing chamber. Results revealed that the TR group had increased movement time variability and did not show performance improvements relative to the LC group. These differences suggest that style of clothing may influence motor performance in women by reallocating cognitive resources towards the body and away from the motor task at hand. This research highlights the interactions between cognitive and motor processes and, potentially, the importance of considering the impact of clothing on performance in many different contexts.

This paper investigates the time caseworkers spend supporting long-term foster care and adoption placements. Undertaken in Australia through collaboration between university and non-government agency researchers, the ‘Cost of Support Study’ tracked the hours that caseworkers spent supporting twenty-seven children and their carers over a nine month period. 3 The placements were part of a ‘Find-A-Family’ program for ‘hard to place children’, many of whom had previously experienced multiple placement breakdowns. The program has a history of 78% stability on the first placement (over the young person's time in the program) and 93% by the second, with the type of support provided by this accredited agency's program detailed here. The weekly worker diaries reveal an average of 3 hours 32 minutes of worker time per week per placement; however wide variation is apparent in the time given to each placement, and depends on the characteristics of the child involved. Further, the resources required to support each placement are found by multiplying worker hours by the hourly cost per worker, using New South Wales government costings. The paper contributes to the important debate regarding the link between worker time and stability in care, by deepening our understanding of the costs involved in providing high quality support and supervision of casework.

Sarah Elizabeth Cox explores the work Tommy's does in research and policy creation to improve support for those who experience a miscarriage.