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AIM: To explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business. DESIGN: A hermeneutic phenomenological approach. PARTICIPANTS: Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling. METHODS: In-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed. RESULTS: Three interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff. CONCLUSIONS: Private practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. CONTRIBUTION OF THE PAPER.
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Fisioterapeutas , Humanos , Reino Unido , Fisioterapeutas/psicologia , Feminino , Prática Privada , Hermenêutica , Masculino , Adulto , Pesquisa Qualitativa , PropriedadeRESUMO
Approximately 5,700 people are diagnosed with myeloma each year in the UK. The standard of care is to receive an autologous stem cell transplant after completion of induction therapy. There are no specific dietary recommendations for people with myeloma, however they are at risk of malnutrition due to symptoms and side effects of treatments. This report describes the journey of a 73-year-old male diagnosed with immunoglobulin A (IgA) lambda myeloma in April 2021. The patient lost 23% of his body weight during 6 months of systemic anti-cancer treatment (SACT), resulting in postponing his transplant twice due to reduced fitness. This report describes an effective, although late, multidisciplinary intervention which was successful for the patient who managed to reestablish a healthy weight and good quality of life. The patient received his transplant in January 2023. This case highlights two important aspects of patient care that should not be underestimated in dietetic clinical practice: early screening and multidisciplinary collaboration. Monitoring the nutritional status of patients and providing early nutrition support can prevent hospital admissions, treatment delays and reduce the associated costs. Multidisciplinary teamwork can improve patient care and clinical outcomes, and it is fundamental to strengthen communication and collaboration among clinical disciplines.
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Desnutrição , Mieloma Múltiplo , Masculino , Humanos , Idoso , Qualidade de Vida , Mieloma Múltiplo/complicações , Mieloma Múltiplo/terapia , Desnutrição/terapia , Desnutrição/diagnóstico , Apoio Nutricional/métodos , Estado NutricionalRESUMO
The origin of life on earth requires the synthesis of protobiopolymers in realistic geologic environments along strictly abiotic pathways that rely on inorganic phases (such as minerals) instead of cellular machinery to promote condensation. One such class of polymer central to biochemistry is the polynucleotides, and oligomerization of activated ribonucleotides has been widely studied. Nonetheless, the range of laboratory conditions tested to date is limited and the impact of realistic early Earth conditions on condensation reactions remains unexplored. Here, we investigate the potential for a variety of minerals to enhance oligomerization using ribonucleotide monomers as one example to model condensation under plausible planetary conditions. The results show that several minerals differing in both structure and composition enhance oligomerization. Sulfide minerals yielded oligomers of comparable lengths to those formed in the presence of clays, with galena being the most effective, yielding oligonucleotides up to six bases long. Montmorillonite continues to excel beyond other clays. Chemical pretreatment of the clay was not required, though maximum oligomer lengths decreased from ~11 to 6 bases. These results demonstrate the diversity of mineral phases that can impact condensation reactions and highlight the need for greater consideration of environmental context when assessing prebiotic synthesis and the origin of life.
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BACKGROUND: The majority of cases of Dent's disease are caused by pathogenic variants in the CLCN5 gene, which encodes a voltage-gated chloride ion channel (ClC-5), resulting in proximal tubular dysfunction. We present three members of the same family and one unrelated paediatric patient with the same insertion-deletion CLCN5 variant. The identification of these patients and positive familial segregation led to the re-classification of this variant from one of unknown significance to one of likely pathogenicity. CASE PRESENTATION: A 41 year old male presented with end stage kidney failure, proteinuria and haematuria. Whole genome sequencing identified an insertion-deletion variant in CLCN5, resulting in a missense change (c.1744_1745delinsAA p.(Ala582Lys)). His brother and nephew, who both exhibited renal impairment, haematuria, proteinuria, glycosuria and nephrocalcinosis, were found to have the same variant. In addition, genetic testing of an unrelated paediatric patient who presented with proteinuria and hypercalciuria, demonstrated the same variant. CONCLUSIONS: The identification of this novel variant in four individuals with features of Dent's disease, has led to the re-classification of the variant to one of likely pathogenicity. As a result, our patients and any future patients with the same variant can be offered a likely diagnosis, without the need for kidney biopsy, and their family members can be offered genetic screening.
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Doença de Dent , Masculino , Humanos , Criança , Adulto , Doença de Dent/diagnóstico , Doença de Dent/genética , Hematúria , Cloretos , Família , ProteinúriaRESUMO
BACKGROUND: A Pharmacy Longitudinal Clerkship (PLC) was designed to develop student pharmacists' (SPs) competence in a general practice setting. AIM: The aim was to carry out a theoretically underpinned qualitative evaluation of stakeholder perceptions of influences of behavioural determinants on SP development for clinical practice in general practice. METHOD: General practice-based PLCs were delivered in 2019/20 and 2020/21 for two cohorts of SPs in NHS Highland, Scotland. Qualitative semi-structured interviews were used to explore stakeholder perceptions of influences of behavioural determinants on SP development. Informed written consent was obtained. An interview schedule was developed and piloted using the Theoretical Domains Framework (TDF). Interviews were recorded, transcribed verbatim and analysed using thematic methodology. Ethics approval was granted. RESULTS: Seven SPs and five general practitioner (GP) tutors were interviewed. Key themes were identified mapped to TDF domains and included: knowledge-utilisation and practical application of knowledge; skills-triangulation of skills under clinical supervision; beliefs about capabilities-confidence building with clinical and patient contact; professional role and identity-elucidation of professional roles within general practice. CONCLUSION: This evaluation shows benefits of embedding SPs within clinical teams and immersing them in a clinical environment over a prolonged period in a general practice Pharmacy Longitudinal Clerkship. It is expected this will translate into a more confident transition to postgraduate professional clinical practice. Funding should be sought to test alternative PLC arrangements including: multiple full-time longitudinal placement blocks; or ultimately a year-long longitudinal clerkship programme with an IPE element.
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Serviços Comunitários de Farmácia , Medicina Geral , Farmácia , Humanos , Atitude do Pessoal de Saúde , Pesquisa Qualitativa , Farmacêuticos , EstudantesRESUMO
BACKGROUND: People living with and beyond cancer are more likely to have comorbid conditions and poorer mental and physical health, but there is a dearth of in-depth research exploring the psychosocial needs of people experiencing cancer and comorbid chronic conditions. A patient partnership approach to research prioritisation and planning can ensure outcomes meaningful to those affected and can inform policy and practice accordingly, but can be challenging. METHODS: We aimed to inform priorities for qualitative inquiry into the experiences and support needs of people living with and beyond cancer with comorbid illness using a partnership approach. A three-step process including a patient workshop to develop a consultation document, online consultation with patients, and academic expert consultation was carried out. The research prioritisation process was also appraised and reflected upon. RESULTS: Six people attended the workshop, ten responded online and eight academic experts commented on the consultation document. Five key priorities were identified for exploration in subsequent qualitative studies, including the diagnostic journey, the burden of symptoms, managing medications, addressing the needs of informal carers, and service provision. Limitations of patient involvement and reflections on procedural ethics, and the challenge of making measurable differences to patient outcomes were discussed. CONCLUSIONS: Findings from this research prioritisation exercise will inform planned qualitative work to explore patients' experiences of living with and beyond cancer with comorbid illness. Including patient partners in the research prioritisation process adds focus and relevance, and feeds into future work and recommendations to improve health and social care for this group of patients. Reflections on the consultation process contribute to a broadening of understanding the field of patient involvement.
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Coastal cities in tropical areas are often low-lying and vulnerable to the effects of flooding and storms. San Juan, Puerto Rico is a good example of this. It is built around a lagoon-channel complex called the San Juan Bay Estuary (SJBE). A critical channel in the estuary, the Caño Martín Peña, has filled in and now frequently floods the surrounding communities with sewage-enriched waters, causing a series of human health and ecological problems. Sediment core analyses indicate that portions of the SJBE now function as settling basins. High urban and sewage runoff to the Caño contributes nitrogen (N), but stable isotope and sediment nutrient analyses indicate that this runoff may also enhance conditions for coupled sulfate reduction-nitrogen fixation. The amount of 'new' bioavailable N created from inert atmospheric N2 gas may meet or exceed that from the runoff into the Caño Martín Peña. The ecological consequences of this appear to extend beyond the ponded channel, potentially contributing to the poor water quality of the SJBE, greater than contaminated runoff alone.
Ciudades costeras en los trópicos generalmente se encuentran localizadas en lugares de baja elevación y vulnerables a los efectos de tormentas e inundaciones. San Juan, Puerto Rico es un buen ejemplo de esto. Esta ciudad fue construida alrededor de un sistema de lagunas y canales que se conoce como el Estuario de la Bahía de San Juan. Un canal crítico en este sistema es el Caño Martín Peña que en el pasado fue rellenado con sedimentos causando inundaciones en las comunidades vecinas. Estas aguas de escorrentía incluyen aguas residuales y aumentado el riesgo a problemas de salud pública y del ambiente. Análisis de los sedimentos indican que porciones de este sistema funcionan como lagunas de sedimentación. Gran flujo de aguas residuales y escorrentía urbana hacia el Caño aportan nitrógeno (N), pero el análisis de sedimentos y nutrientes por isótopos estables indica que esta escorrentía también aumenta las condiciones por procesos acoplados de reducción de sulfato y fijación de nitrógeno. La cantidad de 'nuevo' N biodisponible creado del gas nitrógeno inerte atmosférico podría lograr o exceder esa fijación del nitrógeno derivado de la escorrentía hacia el Caño. Las consecuencias ecológicas de esto parecen extenderse más allá de este canal estancado afectando así la calidad del agua en el Estuario, mayor aún que los contaminantes encontrados en la escorrentía pluvial por sí sola.
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Density-functional theory was used to investigate the effect of atomic impurities on the structural and vibrational properties of zircon (tetragonal ZrSiO4). Atomic impurities considered include radioactive elements U and Th, as well as Hf, Sn, and Ti, substituted on the Zr-site. Using the supercell approach to model a range of substitutional concentrations, impurities were found to cause changes in the volume of the host lattice. This effect was shown to be partially equivalent to the application of a lattice strain. This quantum-based finding is in excellent agreement with the heuristic lattice-strain model traditionally employed in the geosciences to account for the compatibility of impurities in host lattices. Vibrational properties of substituted zircon were also investigated in order to provide a quantum mechanical understanding of Raman spectroscopy measurements on natural zircon. The computational analysis reproduces existing experimental data reported for uranium-substituted zircon and provides general predictive trends for other impurities including Th, Hf, Sn, and Ti. The insights gained by this study regarding the Raman signature of the presence of substitutional impurities set the groundwork for future study of the more substantial lattice disruptions that characterize radiation damage due to alpha decay in zircon.
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RATIONALE: High-precision determination of silicon isotopes can be achieved by in situ multi-collector secondary ion mass spectrometry (MS-SIMS). The accuracy of the analyses is, however, sensitive to ion yields and instrumental mass fractionations (IMFs) induced by the analytical procedure. These effects vary from one instrument to another, with the analytical settings, and with the composition and nature of the sample. Because ion yields and IMF effects are not predictable and rely on empirical calibrations, high-accuracy analyses require suitable sets of standards. METHODS: Here, we document calibrations of ion yields and matrix effects in a set of 23 olivine standards and 3 low-Ca pyroxene for silicon isotopic measurements in both polarities using Cameca IMS 1270 E7 and IMS 1280 HR2 ion probes set with the cesium (Cs) or radiofrequency (RF) source. RESULTS: Silicon ion yields show (i) strong variations with the chemical composition, and (ii) an opposite behavior between the secondary positive and negative polarities. The magnitude of IMF along the fayalite-forsterite (olivine) series shows a complex behavior, increasing overall by ≈7 (secondary positive) and ≈15 (secondary negative) with increasing olivine Mg#. A drastic change in olivine IMF occurs at Mg# ≈ 70 in both polarities. The magnitude of IMF for low-Ca pyroxene from Mg# = 70-100 is almost constant in both polarities, i.e. ≈0.1 in secondary positive and ≈0.15 in secondary negative. The analytical uncertainties on individual analyses were ± 0.05-0.15 (2 S.E.) with both sources, and the external errors for each standard material were ≈ ±0.05-0.5 (2 S.E.) with the Cs source and ≈ ±0.03-0.15 (2 S.E.) with the RF source. CONCLUSIONS: The IMF effect of Si isotopes in silicates shows complex behaviors that vary with the chemistry and the settings of the instrument. We developed a suitable set of standards in order to perform high-accuracy in situ measurements of Si isotopes in olivine and low-Ca pyroxene characterized by varying chemical compositions by MC-SIMS.
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Synthetic hydrogels are investigated extensively in tissue engineering for their tunable physicochemical properties but are bioinert and lack the tissue-specific cues to produce appropriate biological responses. To introduce tissue-specific biochemical cues to these hydrogels, we have developed a modular hydrogel cross-linker, poly(glycolic acid)-poly(ethylene glycol)-poly(glycolic acid)-di(but-2-yne-1,4-dithiol) (PdBT), that can be functionalized with small peptide-based cues and large macromolecular cues simply by mixing PdBT in water with the appropriate biomolecules at room temperature. Cartilage- and bone-specific PdBT macromers were generated by functionalization with a cartilage-associated hydrophobic N-cadherin peptide, a hydrophilic bone morphogenetic protein peptide, and a cartilage-derived glycosaminoglycan, chondroitin sulfate. These biofunctionalized PdBT macromers can spontaneously cross-link polymers such as poly(N-isopropylacrylamide) to produce rapidly cross-linking, highly swollen, cytocompatible, and hydrolytically degradable hydrogels suitable for mesenchymal stem cell encapsulation. These favorable properties, combined with PdBT's modular design and ease of functionalization, establish strong potential for its usage in tissue engineering applications.
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Materiais Biocompatíveis/química , Hidrogéis/química , Engenharia Tecidual , Resinas Acrílicas/química , Animais , Células-Tronco Mesenquimais/citologia , Células-Tronco Mesenquimais/metabolismo , Peptídeos/química , Polietilenoglicóis/química , Polímeros/química , Coelhos , Alicerces Teciduais/químicaRESUMO
Over the past four decades, Long Island, NY, USA, has lost coastal wetlands at a rate of 4% per decade due to submergence. In this study, we examined relationships between the rate of tidal salt marsh loss and environmental factors, including marsh elevation, tidal range, and wastewater exposure through analysis of stable isotope ratios of marsh soils and biota. Our goal was to identify factors that increase vulnerability of marshes to sea level rise, with a specific emphasis on the potential role of poor water quality in hastening marsh loss. Our results suggest that wastewater exposure may accelerate loss of intertidal marsh, but does not negatively impact high tidal marsh resilience to sea level rise. And while marsh elevation and tidal range were statistically significant predictors of marsh loss, they similarly displayed opposite relationships among marsh zones. This study suggests that different functional zones of coastal salt marshes may not respond similarly to global change factors, and that elevation may be an important factor mediating eutrophication effects to coastal salt marshes.
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In situ Raman and Brillouin light scattering techniques were used to study thermally induced high-density amorphous (HDA) to low-density amorphous (LDA) transition in silica glass densified in hot compression (up to 8 GPa at 1100 °C). Hot-compressed silica samples are shown to retain structural and mechanical stability through 600 °C or greater, with reduced sensitivity in elastic response to temperature as compared with pristine silica glass. Given sufficient thermal energy to overcome the energy barrier, the compacted structure of the HDA silica reverts back to the LDA state. The onset temperature for the HDA to LDA transition depends on the degree of densification during hot compression, commencing at lower temperatures for samples with higher density, but all finishing within a temperature range of 250-300 °C. Our studies show that the HDA to LDA transition at high temperatures in hot-compressed samples is different from the gradual changes starting from room temperature in cold-compressed silica glass, indicating greater structural homogeneity achieved by hot compression. Furthermore, the structure and properties of hot-compressed silica glass change continuously during the thermally induced HDA to LDA transition, in contrast to the abrupt and first-order-like polyamorphic transitions in amorphous ice. Different HDA to LDA transition mechanisms in amorphous silica and amorphous ice are explained by their different energy landscapes.
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The structure and composition of granites provide clues to the nature of silicic volcanism, the formation of continents, and the rheological and thermal properties of the Earth's upper crust as far back as the Hadean eon during the nascent stages of the planet's formation1-4. The temperature of granite crystallization underpins our thinking about many of these phenomena, but evidence is emerging that this temperature may not be well constrained. The prevailing paradigm holds that granitic mineral assemblages crystallize entirely at or above about 650-700 degrees Celsius5-7. The granitoids of the Tuolumne Intrusive Suite in California tell a different story. Here we show that quartz crystals in Tuolumne samples record crystallization temperatures of 474-561 degrees Celsius. Titanium-in-quartz thermobarometry and diffusion modelling of titanium concentrations in quartz indicate that a sizeable proportion of the mineral assemblage of granitic rocks (for example, more than 80 per cent of the quartz) crystallizes about 100-200 degrees Celsius below the accepted solidus. This has widespread implications. Traditional models of magma formation require high-temperature magma bodies, but new data8,9 suggest that volcanic rocks spend most of their existence at low temperatures; because granites are the intrusive complements of volcanic rocks, our downward revision of granite crystallization temperatures supports the observations of cold magma storage. It also affects the link between volcanoes, ore deposits and granites: ore bodies are fed by the release of fluids from granites below them in the crustal column; thus, if granitic fluids are hundreds of degrees cooler than previously thought, this has implications for research on porphyry ore deposits. Geophysical interpretations of the thermal structure of the crust and the temperature of active magmatic systems will also be affected.
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Background: Impairments in social communication are a core feature of Autism Spectrum Disorder (ASD). Because the ability to infer other people's emotions from their facial expressions is critical for many aspects of social communication, deficits in expression recognition are a plausible candidate marker for ASD. However, previous studies on facial expression recognition produced mixed results, which may be due to differences in the sensitivity of the many tests used and/or the heterogeneity among individuals with ASD. To ascertain whether expression recognition may serve as a diagnostic marker (which distinguishes people with ASD from a comparison group) or a stratification marker (which helps to divide ASD into more homogeneous subgroups), a crucial first step is to move beyond identification of mean group differences and to better understand the frequency and severity of impairments. Methods: This study tested 46 individuals with ASD and 52 age- and IQ-matched typically developing (TD) participants on the Films Expression Task, which combines three key features of real-life expression recognition: naturalistic facial expressions, a broad range of simple and complex emotions, and short presentation time. Test-retest reliability was assessed in 28 individuals who did not participate in the main study and revealed acceptable reliability (ICC r = .74). Results: Case-control comparisons showed highly significant mean group differences for accuracy (p = 1.1 × 10- 10), with an effect size (Cohen's d = 1.6), more than twice as large as the mean effect size reported in a previous meta-analysis (Uljarevic and Hamilton, 2012, J Autism Dev Disord). The ASD group also had significantly increased mean reaction times overall (p = .00015, d = .83) and on correct trials (p = .0002, d = .78). However, whereas 63% of people with ASD showed severe deficits (they performed below two standard deviations of the TD mean, a small subgroup (15.3%) performed normally (within one standard deviation of the mean). Conclusion: These findings indicate that the majority of people with ASD have severe expression recognition deficits and that the Films Expression Test is a sensitive task for biomarker research in ASD. Future work is needed to establish whether ASD subgroups with and without expression recognition deficits differ from one another in terms of their symptom profile or neurobiological underpinnings.
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Transtorno do Espectro Autista/fisiopatologia , Emoções , Reconhecimento Facial , Adolescente , Adulto , Transtorno do Espectro Autista/diagnóstico , Estudos de Casos e Controles , Expressão Facial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes NeuropsicológicosRESUMO
BACKGROUND: The assessment of fear of recurrence (FCR) is crucial for understanding an important psychological state in patients diagnosed and treated for cancer. The study aim was to determine psychometric details of a seven question self-report scale (FCR7) and a short form (FCR4) based upon items already used in various extensive measures of FCR. METHODS: Two consecutive samples of patients (breast and colorectal) were recruited from a single specialist cancer centre. The survey instrument contained the FCR7 items, Hospital Anxiety and Depression Scale (HADS), and demographic details. Clinical information was obtained from patient hospital records. Statistical analyses were performed using classical test and item response theory approaches, to demonstrate unidimensional factor structure and testing key parameters. Construct validity was inspected through nomological and theoretical prediction. RESULTS: Internal consistency was demonstrated by alpha coefficients (FCR4: 0.93 and FCR7: 0.92). Both scales (FCR7 & FCR4) were associated with the HADs subscales as predicted. Patients who experienced chemotherapy, minor aches/pains, thought avoidance of cancer and high cancer risk belief were more fearful. Detailed inspection of item responses profile provided some support for measurement properties of scales. CONCLUSION: The internal consistency, and pattern of key associations and discriminability indices provided positive psychometric evidence for these scales. The brief measures of FCR may be considered for audit, screening or routine use in clinical service and research investigations.
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Neoplasias da Mama/psicologia , Neoplasias Colorretais/psicologia , Medo , Recidiva Local de Neoplasia/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Neoplasias da Mama/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , AutorrelatoRESUMO
Adherence to adjuvant endocrine therapy (AET) following breast cancer is known to be suboptimal despite its known efficacy in reducing recurrence and mortality. This study aims to investigate factors associated with non-adherence and inform the development of interventions to support women and promote adherence. A questionnaire survey to measure level of adherence, side effects experienced, beliefs about medicine, support received and socio-demographic details was sent to 292 women 2-4 years post breast cancer diagnosis. Differences between non-adherers and adherers to AET were explored, and factors associated with intentional and unintentional non-adherence are reported. Approximately one quarter of respondents, 46 (22%), were non-adherers, comprising 29 (14%) intentional non-adherers and 17 (8%) unintentional non-adherers. Factors significantly associated with intentional non-adherence were the presence of side effects (p < .03), greater concerns about AET (p < .001) and a lower perceived necessity to take AET (p < .001). Half of the sample (105/211) reported that side effects had a moderate or high impact on their quality of life. Factors associated with unintentional non-adherence were younger age (<65) (p < .001), post-secondary education (p = .046) and paid employment (p = .031). There are distinct differences between intentional non-adherence and unintentional non-adherence. Differentiation between the two types of non-adherence may help tailor support and advice interventions.
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Androstadienos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-IdadeRESUMO
Pharmacometric analyses are complex and multifactorial. It is essential to check, track, and document the vast amounts of data and metadata that are generated during these analyses (and the relationships between them) in order to comply with regulations, support quality control, auditing, and reporting. It is, however, challenging, tedious, error-prone, and time-consuming, and diverts pharmacometricians from the more useful business of doing science. Automating this process would save time, reduce transcriptional errors, support the retention and transfer of knowledge, encourage good practice, and help ensure that pharmacometric analyses appropriately impact decisions. The ability to document, communicate, and reconstruct a complete pharmacometric analysis using an open standard would have considerable benefits. In this article, the Innovative Medicines Initiative (IMI) Drug Disease Model Resources (DDMoRe) consortium proposes a set of standards to facilitate the capture, storage, and reporting of knowledge (including assumptions and decisions) in the context of model-informed drug discovery and development (MID3), as well as to support reproducibility: "Thoughtflow." A prototype software implementation is provided.
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Descoberta de Drogas , Modelos Biológicos , Software , Humanos , Fluxo de TrabalhoRESUMO
Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy.
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Exercício Físico , Fenômenos Fisiológicos da Nutrição do Lactente , Desnutrição/prevenção & controle , Fenômenos Fisiológicos da Nutrição Materna , Atividade Motora , Estado Nutricional , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , África do SulRESUMO
Prostate cancer (PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) (n = 7 papers), unpartnered (n = 17 papers) or gay or bisexual men (n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being "out of sync"; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups.