Antimalarial resistance risk in Mozambique detected by a novel quadruplex droplet digital PCR assay.

While the Plasmodium falciparum malaria parasite continues to cause severe disease globally, Mozambique is disproportionally represented in malaria case totals. Acquisition of copy number variations (CNVs) in the parasite genome contributes to antimalarial drug resistance through overexpression of drug targets. Of interest, piperaquine resistance is associated with plasmepsin 2 and 3 CNVs (pfpmp2 and pfpmp3, respectively), while CNVs in the multidrug efflux pump, multidrug resistance-1 (pfmdr1), increase resistance to amodiaquine and lumefantrine. These antimalarials are partner drugs in artemisinin combination therapies (ACTs) and therefore, CNV detection with accurate and efficient tools is necessary to track ACT resistance risk. Here, we evaluated ~300 clinically derived samples collected from three sites in Mozambique for resistance-associated CNVs. We developed a novel, medium-throughput, quadruplex droplet digital PCR (ddPCR) assay to simultaneously quantify the copy number of pfpmp3, pfpmp2, and pfmdr1 loci in these clinical samples. By using DNA from laboratory parasite lines, we show that this nanodroplet-based method is capable of detecting picogram levels of parasite DNA, which facilitates its application for low yield and human host-contaminated clinical surveillance samples. Following ddPCR and the application of quality control standards, we detected CNVs in 13 of 229 high-quality samples (prevalence of 5.7%). Overall, our study revealed a low number of resistance CNVs present in the parasite population across all three collection sites, including various combinations of pfmdr1, pfpmp2, and pfpmp3 CNVs. The potential for future ACT resistance across Mozambique emphasizes the need for continued molecular surveillance across the region.

The role of community pharmacists and pharmacies in physical activity promotion: an interdisciplinary e-Delphi study.

BACKGROUND: Physical activity has a key role in the prevention and control of noncommunicable diseases. Community pharmacists are an accessible source to provide brief advice to people on how to be more physically active. Nonetheless, there is a limited understanding of stakeholders' perspectives on their role in promoting physical activity, to inform policy and practice. The present study addresses this gap. AIM: To determine consensus from different health professionals on the role of pharmacists and pharmacies in brief physical activity counselling in Portugal. METHOD: This cross-sectional study used a two-round e-Delphi panel. The questionnaire was organised into four domains of physical activity promotion and comprised 37 items. Interdisciplinary experts rated their level of agreement using a 5-point Likert scale. Consensus was set at the outset as 75% or more of participants scoring 4 or 5 (consensus "in") or 1 or 2 (consensus "out"). RESULTS: Forty-two health professionals involved in promoting physical activity in the ambulatory setting in Portugal were selected through purposive quota sampling. Eighteen out of 37 items were consensual in the first round and five more achieved consensus after the second round (62.2%). Physical activity promotion was seen as the role of all healthcare workforce and pharmacies were considered as suitable spaces for service provision, regardless of remuneration. CONCLUSION: This study endorses a set of roles for physical activity promotion in community pharmacy from an interdisciplinary perspective. Consensually established perspectives can inform policy making and practice, streamlining the coordination of pharmacies with the national health service.

Pharmacists' involvement in physical activity promotion in community pharmacy: a systematic review.

BACKGROUND: Physical activity (PA) promotion in healthcare systems is one of the priority areas highlighted by the World Health Organization, which recognizes that progress has been slow largely due to a lack of awareness and investment while requiring a system-based approach. Community pharmacies are one of the health structures that are more easily accessible to populations, thus constituting an ideal venue for developing health promotion activities. This research aimed to describe PA-enabling interventions developed in community pharmacies by pharmacists. METHODS: An electronic search was performed in PubMed, Scopus, Web of Science, Cochrane and reference lists of the different papers until June 2023. Studies were eligible if performed in community pharmacies by pharmacists, focused on interventions aimed at increasing PA levels and if at least one PA-specific outcome was measured at two different time points. RESULTS: We identified 7076 publications in the initial search, plus 31 records identified through backward citation tracking from relevant studies. After an initial screening, 236 were selected for full-text analysis. Of the 29 selected papers, 10 presented a low risk of bias for the measurement of PA levels. PA outcomes were generally self-reported outcomes where the change in terms of the percentage of individuals considered active or who increased PA because of the intervention. CONCLUSION: Several interventions to improve PA through community pharmacies were found although with a high level of heterogeneity and with only few with a low risk of bias. More targeted research that aims to capture PA levels and support the training of healthcare professionals is needed.

Physical activity promotion in the community pharmacy: An opportunity for an expanded role?

BACKGROUND: Physical inactivity is a major risk factor for the development of chronic diseases, and it is increasingly prevalent in the Portuguese population. Pharmacists' role in promoting physical activity (PA) is still not well established, although health promotion is foreseen by law in Portugal. Competing tasks and location where the pharmacy is embedded can hinder this promotion in their daily practice. OBJECTIVE: The aim of this study was to identify the main barriers and facilitators of physical activity promotion (PAP) in Portuguese community pharmacies and explore possible pathways for future implementation of physical activity promotion. METHODS: In-depth, semi-structured interviews were conducted with purposively enrolled community pharmacists. Participant recruitment was aligned with data saturation. Data analysis comprised a mixed model of a deductive theme mapping strategy using the Theoretical Domains Framework (TDF) for the behaviour of promoting physical activity and an inductive approach for any other relevant themes and which might influence PA promotion. RESULTS: Data saturation was reached at eleven interviews. Barriers and facilitators for the behaviour of promoting PA were identified from 11 out of the 14 TDF domains. Following an inductive approach, other emerging codes were clustered in additional seven major themes. Highlighted barriers focused on domains #1 - Knowledge, #10 - Memory, Attention and Decision Processes and #13 - Environmental Context and Resources. Community mapping, establishment of remuneration models and the use of digital technologies were suggested as additional potential contributors to scale up PAP. CONCLUSION: Community pharmacists are well placed inside their communities to serve as a focal point for signposting, engagement with other healthcare professionals and community resources and activities organized by the pharmacy itself. Pharmacists should be supported in being knowledgeable, aware, and available when promoting PA in their daily counseling.

Relationship of the SITLESS intervention on medication use in community-dwelling older adults: an exploratory study.

Background: Sedentary behavior (SB) and physical activity (PA) interventions in older adults can improve health outcomes. Problems related with aging include prevalent comorbidity, multiple non-communicable diseases, complaints, and resulting polypharmacy. This manuscript examines the relationship between an intervention aiming at reducing SB on medication patterns. Method: This manuscript presents a local sub-analysis of the SITLESS trial data on medication use. SITLESS was an exercise referral scheme (ERS) enhanced by self-management strategies (SMS) to reduce SB in community-dwelling older adults. We analyzed data from the ERS + SMS, ERS and usual care (UC) groups. Patient medication records were available at baseline and at the end of the intervention (4-month period) and were analyzed to explore the effect of SITLESS on medication patterns of use. Result: A sample of 75 participants was analyzed, mostly older overweight women with poor body composition scores and mobility limitations. There was a significant reduction of 1.6 medicines (SD = 2.7) in the ERS group (p < 0.01), but not in the UC or ERS + SMS groups. Differences were more evident in medicines used for short periods of time. Conclusion: The findings suggest that an exercise-based program enhanced by SMS to reduce SB might influence medication use for acute conditions but there is a need to further investigate effects on long-term medicine use in older adults.

In-Lab Demonstration of an Underwater Acoustic Spiral Source.

Underwater acoustic spiral sources can generate spiral acoustic fields where the phase depends on the bearing angle. This allows estimating the bearing angle of a single hydrophone relative to a single source and implementing localization equipment, e.g., for target detection or unmanned underwater vehicle navigation, without requiring an array of hydrophones and/or projectors. A spiral acoustic source prototype made out of a single standard piezoceramic cylinder, which is able to generate both spiral and circular fields, is presented. This paper reports the prototyping process and the multi-frequency acoustic tests performed in a water tank where the spiral source was characterized in terms of the transmitting voltage response, phase, and horizontal and vertical directivity patterns. A receiving calibration method for the spiral source is proposed and showed a maximum angle error of 3° when the calibration and the operation were carried out in the same conditions and a mean angle error of up to 6° for frequencies above 25 kHz when the same conditions were not fulfilled.

Anti-malarial resistance in Mozambique: Absence of Plasmodium falciparum Kelch 13 (K13) propeller domain polymorphisms associated with resistance to artemisinins.

BACKGROUND: Malaria remains one of the most serious public health problems in sub-Saharan Africa and Mozambique is the world's fourth largest contributor, with 4.7% of disease cases and 3.6% of total deaths due to malaria. Its control relies on the fight against the vector and treatment of confirmed cases with anti-malarial drugs. Molecular surveillance is an important tool for monitoring the spread of anti-malarial drug resistance. METHODS: A cross-sectional study recruited 450 participants with malaria infection detected by Rapid Diagnostic Tests, from three different study sites (Niassa, Manica and Maputo) between April and August 2021. Correspondent blood samples were collected on filter paper (Whatman® FTA® cards), parasite DNA extracted and pfk13 gene sequenced using Sanger method. SIFT software (Sorting Intolerant From Tolerant) was used, predict whether an amino acid substitution affects protein function. RESULTS: No pfkelch13-mediated artemisinin resistance gene mutation was detected in this study settings. However, non-synonymous mutations were detected at prevalence of 10.2%, 6% and 5% in Niassa, Manica and Maputo, respectively. Most (56.3%) of the reported non-synonymous mutations were due to substitution at the first base of the codon, 25% at the second base and 18.8% at the third base. Additionally, 50% of non-synonymous mutations showed a SIFTscore bellow cut off value of 0.05, therefore, they were predicted to be deleterious. CONCLUSION: These results do not show an emergence of artemisinin resistance cases in Mozambique. However, the increased number of novel non-synonymous mutations highlights the relevance of increasing the number of studies focused on the molecular surveillance of artemisinin resistance markers, for its early detection.

Telepharmacy and pharmaceutical care: A narrative review by International Pharmaceutical Federation.

Digital transformation impacts health care through technology. Telepharmacy is set to become one of the most important aspects of Telemedicine in the years  to come with its ability to provide patients with increased and more timely  access to pharmaceutical care, reduced costs for individuals and health  systems, improved patient satisfaction, experience and convenience, and  better health outcomes. Telepharmacy has gained increasing importance in the delivery of pharmaceutical care, largely due to the COVID-19 pandemic which  has placed enormous pressures on healthcare systems globally. There is a  significant amount of published literature from different countries around the  world that provide examples of Telepharmacy. There are some innovative  models of Telepharmacy services aimed at optimizing and improving access to  pharmaceutical care, resulting in improved patient safety and outcomes. The  benefits of Telepharmacy include increased value for pharmacies and  pharmacists and adapting to patients´ needs, enhanced interprofessional care  and increased efficiency of health systems and increased provision of patient- centred services, among others. However, despite these benefits, major  barriers for implementation of Telepharmacy remain such as patient  confidentiality and privacy of health information. These barriers to the  implementation of Telepharmacy have been identified and can be divided into  four different environments: technological, organizational, human and  economic. Delivering pharmaceutical care and services through digital media is identified as a key priority for the International Pharmaceutical Federation. Digital health is one of the 21 Development Goals launched by International Pharmaceutical Federation in 2020. The International Pharmaceutical Federation Digital Health in Pharmacy Education report in 2021, describes the  readiness, adaptability and responsiveness of pharmacy education and  knowledge and skill needs of pharmaceutical workforce on digital health.  Amongst other digital health tools, telehealth/Telepharmacy has been reported  as one of the most preferred tools to teach and learn about by respondents.

La tecnología surgida de la transformación digital ha traído consigo cambios en la asistencia sanitaria. En los próximos años, la Telefarmacia previsiblemente  se convertirá en uno de los aspectos más importantes de la Telemedicina, ya  que ofrece a los pacientes un acceso más inmediato a la atención  farmacéutica, supone una reducción de costes tanto para los pacientes como  para los sistemas sanitarios, y deriva en una mayor satisfacción, experiencia y  comodidad de los pacientes, mejorando así los resultados clínicos. Debido en  gran medida a la pandemia de COVID­19, la Telefarmacia ha adquirido gran  importancia en el ámbito de la atención farmacéutica, ya que esta crisis ha  provocado una enorme presión sobre los sistemas sanitarios de todo el mundo. Se pueden encontrar multitud de experiencias publicadas en la literatura  científica sobre modelos de Telefarmacia en diferentes países del mundo.  Existen algunos modelos innovadores de servicios de Telefarmacia orientados a  optimizar y mejorar el acceso a la atención farmacéutica, lo que se traduce  en una mejora de la seguridad y los resultados de los pacientes. Entre las  ventajas de la Telefarmacia se incluye el aumento del valor para las farmacias  y los farmacéuticos y la adaptación a las necesidades de los pacientes, la mejora de la atención interprofesional, el aumento de la eficiencia de los  sistemas sanitarios y la mayor prestación de servicios centrados en el paciente, entre otras. Sin embargo, a pesar de presentar múltiples ventajas, siguen  existiendo importantes barreras para la implantación de la Telefarmacia, como  la confidencialidad del paciente y la privacidad de la información clínica. Estas  barreras para la implantación de la Telefarmacia pueden dividirse en cuatro  ámbitos: tecnológico, organizativo, humano y económico. La prestación de  atención y servicios farmacéuticos a través de medios digitales es una  prioridad clave de la Federación Internacional Farmacéutica. La salud digital es  uno de los 21 Objetivos de Desarrollo lanzados por la Federación Internacional  Farmacéutica en 2020. El informe de la Federación Internacional Farmacéutica  sobre salud digital en la formación farmacéutica en 2021 describe la  preparación, adaptabilidad y capacidad de respuesta de la formación  farmacéutica y las necesidades de conocimientos y habilidades de los  farmacéuticos sobre la salud digital. Entre otras herramientas de salud digital,  la Telemedicina/Telefarmacia ha sido señalada como una de las herramientas  preferidas por los encuestados para formar y aprender.

Physical activity promotion in community pharmacies: pharmacists' attitudes and behaviours.

BACKGROUND: Health systems and their professionals play a key role in the promotion and maintenance of behaviours contributing to increased physical activity levels. Pharmacists are well placed within communities, making them an accessible source to provide brief advice to people on how to be more physically active. OBJECTIVE: This study aimed to characterize physical activity promotion actions taking place in the Portuguese community pharmacies, as well as the major facilitators and barriers faced by pharmacists in their daily practice. METHODS: A cross-sectional study based on an online questionnaire targeting community pharmacists was developed based on COM-B model and the Theoretical Domains Framework (TDF) and distributed by email to 94% of the Portuguese pharmacies. RESULTS: In total, 396 complete responses from community pharmacists were obtained. Three out of four participants reported to promote physical activity in their daily routine, of which 87.7% reported doing it in only a few attendances. The majority (92.3%) mentioned to provide information orally, with walking being the activity most promoted (99.4%). More active and younger pharmacists were more likely to promote physical activity. Nearly all pharmacists (98.7%) believed it was important or very important to practice regular physical activity for the health, but only 41.4% of the respondents were able to correctly identify the WHO general recommendations for physical activity. The lack of coordination with other healthcare professionals (M=3.35; SD=1.11), lack of interest by customers (M=3.25; SD=1.09) and lack of time (M=3.06; SD=1.10) were the main barriers to physical activity promotion, all scoring above the scale mid-point (i.e., 3). CONCLUSIONS: Physical activity promotion in the Portuguese community pharmacies is still not present as daily activity. Younger pharmacists seem to be a generation that better understand this need and could easily integrate this practice in their daily routine. Possibilities for including pharmacies and pharmacists as promoters of physical activity in the primary health care sector in the future are discussed in the light of these findings.