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.

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.

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.