Compliance with and acceptability of two fortified balanced energy protein supplements among pregnant women in rural Nepal

Some evidence suggests that balanced energy protein (BEP) supplements taken during pregnancy and lactation can have positive effects on birth outcomes such as small‐for‐gestational age and birthweight, but more evidence is needed on the long‐term use and acceptability of such supplements. We conducted a mixed‐methods formative research study to assess and compare compliance with and acceptability of two BEP supplements, a lipid‐based peanut paste and a biscuit, to identify BEP supplements for subsequent inclusion in an efficacy trial. We conducted an 8‐week feeding trial of daily supplementation among two groups of 40 pregnant women each in rural Nepal. Compliance data were collected and supplements distributed at the weekly visits. Sensory properties of the supplements were assessed using a 7‐point Likert scale. In addition, in‐depth interviews with women (n = 16), family members (n = 6) and health workers (n = 6) and focus group discussions (FGDs) (n = 4) were conducted to explore themes related to general use and intention of future use of the supplement. Overall self‐reported compliance was high: medians of 91.1% in the lipid‐based peanut paste group and 96.4% in the biscuit group. Both supplements were rated highly on overall likability (median score 6/7) and sensory properties. Qualitative findings showed that sustained use of the supplements was attributed to expected health benefits, favourable sensory attributes, and family support. The FGDs suggested providing the option to choose between more than one type/flavour of supplements to improve compliance. Sharing was mostly evident in the first week with higher sharing reported in the biscuit group.     

Multiple water source use in rural Vanuatu: are households choosing the safest option for drinking?

Households in low- and middle-income countries commonly make use of multiple water sources. However, it remains unclear to what extent their drinking water choices are optimal from a health perspective. This matched cohort study across 10 islands in Vanuatu examined communities with both a groundwater and rainwater source to determine whether their preferred drinking option was the safest in microbial terms. In communities that preferred to drink rainwater, 56.5% of rainwater sources had ‘high-risk’ or ‘very high risk’ Escherichia coli contamination (> 10 MPN/100 mL) compared with 26.1% of groundwater sources (p = 0.092). Moreover, a preference for drinking rainwater was significantly associated with rainwater sources having ‘high-risk’ or ‘very high risk’ levels of E. coli contamination (p = 0.045). Results show that communities do not necessarily choose the safest water source for drinking. Findings also highlight the need to bolster local capacity to manage water quality risks and for Sustainable Development Goal monitoring to distinguish between protected and unprotected rainwater tanks.     

Cultural Consensus Analysis as a Tool for Clinic Improvements

Some problems in clinic function recur because of unexpected value differences between patients, faculty, and residents. Cultural consensus analysis (CCA) is a method used by anthropologists to identify groups with shared values. After conducting an ethnographic study and using focus groups, we developed and validated a CCA tool for use in clinics. Using this instrument, we identified distinct groups with 6 important value differences between those groups. An analysis of these value differences suggested specific and pragmatic interventions to improve clinic functioning. The instrument has also performed well in preliminary tests at another clinic.     

Interfering with resistance to smoothened antagonists by inhibition of the PI3K pathway in medulloblastoma

The malignant brain cancer medulloblastoma is characterized by mutations in Hedgehog (Hh) signaling pathway genes, which lead to constitutive activation of the G protein (heterotrimeric guanosine triphosphate-binding protein)-coupled receptor Smoothened (Smo). The Smo antagonist NVP-LDE225 inhibits Hh signaling and induces tumor regression in animal models of medulloblastoma. However, evidence of resistance was observed during the course of treatment. Molecular analysis of resistant tumors revealed several resistance mechanisms. We noted chromosomal amplification of Gli2, a downstream effector of Hh signaling, and, more rarely, point mutations in Smo that led to reactivated Hh signaling and restored tumor growth. Analysis of pathway gene expression signatures also, unexpectedly, identified up-regulation of phosphatidylinositol 3-kinase (PI3K) signaling in resistant tumors as another potential mechanism of resistance. Probing the relevance of increased PI3K signaling, we demonstrated that addition of the PI3K inhibitor NVP-BKM120 or the dual PI3K-mTOR (mammalian target of rapamycin) inhibitor NVP-BEZ235 to the initial treatment with the Smo antagonist markedly delayed the development of resistance. Our findings may be useful in informing treatment strategies for medulloblastoma.     

Membrane potentials in Rana temporaria muscle fibres in strongly hypertonic solutions

Conventional microelectrode methods were used to measure variations in resting membrane potentials, E _m, of intact amphibian skeletal muscle fibres over a wide range of increased extracellular tonicities produced by inclusion of varying extracellular concentrations of sucrose. Moderate increases in extracellular tonicity to up to 2.6× normal (2.6τ) under Cl⁻ free conditions produced negative shifts in E _m that followed expectations for the K⁺ Nernst equation (E _K) applied to a perfect osmometer containing a conserved intracellular K⁺ content despite any accompanying cell volume change. In contrast, E _m remained stable in fibres studied in otherwise similar Cl⁻ containing solutions, consistent with E _m stabilization despite negative shifts in E _K through inward cation-Cl⁻ co-transport activity. Short exposures to higher tonicities (>3τ) similarly produced negative shifts in E _m in Cl⁻ free but not Cl⁻ containing solutions. However, prolonged exposures to solutions of >3τ caused gradual net positive changes in E _m in both Cl⁻ containing and Cl⁻ free solutions suggesting that these changes were independent of cation-Cl⁻ transport. Indeed, there was no evidence of cation-Cl⁻ co-transport activity in strongly hypertonic solutions despite its predicted energetic favourability, suggesting its possible regulation by E _m in muscle. Additional findings implicated a failure to maintain greatly increased transmembrane [K⁺] gradients in these E _m changes. Thus: (1) halving or doubling [K⁺]_e produced negative or positive shifts␣in E _m, respectively in isotonic or moderately hypertonic (<2.7τ), but not strongly hypertonic (>3τ) solutions; (2) subsequent restoration of isotonic extracellular conditions produced further positive changes in E _m consistent with a dilution of the depleted [K⁺]_i by fibres regaining their original resting volumes; (3) quantitative modelling similarly predicted a gradual net efflux of K⁺ as the balance between active and passive [K⁺] fluxes altered due to increased transmembrane [K⁺] gradients in hypertonic and low [K⁺]_e solutions. However, the observed positive changes in E _m in the most strongly hypertonic solutions eventually exceeded these predictions suggesting additional limitations on␣Na⁺/K⁺-ATPase activity in strongly hypertonic solutions.James A. Fraser and Kai Yuen Wong have equally contributed to this paper.     

Hurdles and opportunities for newborn care in rural Uganda

Introduction

a set of evidence-based delivery and neonatal practices have the potential to reduce neonatal mortality substantially. However, resistance to the acceptance and adoption of these practices may still be a problem and challenge in the rural community in Uganda.

Objectives

to explore the acceptability and feasibility of the newborn care practices at household and family level in the rural communities in different regions of Uganda with regards to birth asphyxia, thermo-protection and cord care.

Methods

a qualitative design using in-depth interviews and focus group discussions were used. Participants were purposively selected from rural communities in three districts. Six in-depth interviews targeting traditional birth attendants and nine focus group discussions composed of 10–15 participants among post childbirth mothers, elderly caregivers and partners or fathers of recently delivered mothers were conducted. All the mothers involved has had normal vaginal deliveries in the rural community with unskilled birth attendants. Latent content analysis was used.

Findings

two main themes emerged from the interviews: ‘Barriers to change’ and ‘Windows of opportunities’. Some of the recommended newborn practices were deemed to conflict with traditional and cultural practices. Promotion of delayed bathing as a thermo-protection measure, dry cord care were unlikely to be accepted and spiritual beliefs were attached to use of local herbs for bathing or smearing of the baby’s skin. However, several aspects of thermo-protection of the newborn, breast feeding, taking newborns for immunisation were in agreement with biomedical recommendations, and positive aspects of newborn care were noticed with the traditional birth attendants.

Conclusions

some of the evidence based practices may be accepted after modification. Behaviour change communication messages need to address the community norms in the country. The involvement of other newborn caregivers than the mother at the household and the community early during pregnancy may influence change of behaviour related to the adoption of the recommended newborn care practices.     

Effective activation alleviates the replication block of CCR5-tropic HIV-1 in chimpanzee CD4+ lymphocytes

Human immunodeficiency virus type 1 (HIV-1) originated in chimpanzees; yet, several previous studies have shown that primary HIV-1 isolates replicate poorly in chimpanzee CD4+ T lymphocytes in vitro and in vivo. The reasons for this apparent restriction are not understood. Here, we describe a new activation protocol that led to a reproducible expansion and activation of chimpanzee CD4+ T lymphocytes in vitro. Using this protocol, we uncovered species-specific differences in the activation profiles of human and chimpanzee CD4+ T-cells, including HLA-DR and CD62L. Moreover, we found that improved activation facilitated the replication of both CXCR4 and CCR5-tropic HIV-1 in CD4+ T-cell cultures from over 30 different chimpanzees. Thus, the previously reported “replication block” of CCR5-tropic HIV-1 in chimpanzee lymphocytes appears to be due, at least in large part, to suboptimal T-cell activation.     

A National Survey of Canadian Adults on HPV: Knowledge,Attitudes, and Barriers to the HPV Vaccine

ObjectiveIdentifying human papillomavirus (HPV) vaccination motivators and barriers among adults could lead to new approaches to improve HPV vaccination rates in non-pediatric populations. This Canadian survey aimed to assess current knowledge of, attitudes towards, and barriers to the HPV vaccine among the general public.MethodsAn online panel was used to survey HPV unvaccinated women (n = 802) and vaccinated women (n = 250) 18 to 45 years old, as well as 18- to 26-year-old men (n = 200), in May and June 2016. A 16-item questionnaire collected data on sociodemographic factors, health-seeking behaviours, knowledge of HPV infection and its consequences, and the HPV vaccine. Data were stratified by sex and by vaccination status among women.ResultsThe majority of individuals somewhat or strongly agreed that vaccination is an important aspect of disease prevention (vaccinated women, 93%; unvaccinated women, 85%; and men, 59%). However, a high proportion of patients were concerned about vaccine safety (vaccinated women, 26%; unvaccinated women, 40%; and men, 36%). Moreover, 58% to 61% of participants were generally cautious about taking any vaccine. The number one reported barrier to vaccination was not having a recommendation from a doctor (38%). Cost was seen as a barrier by only 18% to 20% of participants.ConclusionCanadian participants show a broad diversity in HPV knowledge and regarding barriers to vaccination. The youngest populations (vaccinated women and men) showed higher levels of knowledge regarding HPV.