Monkeypox-Associated Central Nervous System Disease: A Case Series and Review.

OBJECTIVE: Monkeypox virus (MPXV) disease has been declared a public health emergency by the World Health Organization, creating an urgent need for neurologists to be able to recognize, diagnosis, and treat MPXV-associated neurologic disease. METHODS: Three cases of MPXV-associated central nervous system (CNS) disease occurring during the 2022 outbreak, and their associated imaging findings are presented, with 2 cases previously published in a limited capacity in a public health bulletin. RESULTS: Three previously healthy immunocompetent gay men in their 30s developed a febrile illness followed by progressive neurologic symptoms with presence of a vesiculopustular rash. MPXV nucleic acid was detected by polymerase chain reaction (PCR) from skin lesions of 2 patients, with the third patient having indeterminate testing but an epidemiologic link to a confirmed MPXV disease case. Cerebrospinal fluid demonstrated a lymphocytic pleocytosis, elevated protein, and negative MPXV-specific PCR. In 2 patients, magnetic resonance imaging of the brain and spine demonstrated partially enhancing, longitudinally extensive central spinal cord lesions with multifocal subcortical, basal ganglia, thalamic, cerebellar, and/or brainstem lesions. The third patient had thalamic and basal ganglia lesions. All patients received 14 days of tecovirimat, and 2 patients also received multiple forms of immunotherapy, including intravenous immunoglobulin, pulsed high-dose steroids, plasmapheresis, and/or rituximab. Good neurologic recovery was observed in all cases. INTERPRETATION: MPXV can be associated with CNS disease. It is unclear whether this is from a parainfectious immune-mediated injury or direct CNS viral invasion. ANN NEUROL 2023;93:893-905.

Towards a home-grown rural health workforce: Evidence from Tasmania, Australia.

OBJECTIVE: To examine the association between place of origin and principal place of practice (PPP) of domestic Tasmanian health graduates who received end-to-end training with the University of Tasmania (UTAS). METHODS: The 2022 PPP for all UTAS domestic Tasmanian graduates from medicine, nursing, pharmacy, psychology, medical radiation science and paramedicine between 2011 and 2020 was identified using the online Australian Health Practitioner Regulation Agency (Ahpra) registration database. The graduate's place of origin (home address at the time of course application), together with their 2022 PPP, was described using the Modified Monash Model (MM) classification system of remoteness. Data were analysed using STATA. RESULTS: Over the 10-year period, 4079 domestic Tasmanians graduated from health courses at UTAS, of which 3850 (94.4%) were matched to an Australian PPP. In all, 78.3% of graduates were working in Tasmania, while the remainder (21.7%) were employed interstate. Of those with a Tasmanian PPP, 81.4% were working in a regional setting (MM2), while 77.6% of interstate employed graduates recorded a metropolitan (MM1) PPP. Rural place of origin (MM3-7) was associated with rural employment (MM3-7) in both Tasmania (OR, 37.08; 95% CI 29.01-47.39, p < 0.001), and on the Australian mainland (OR, 21.4; 95% CI 17.4-26.3, p < 0.001). CONCLUSIONS: Most domestic Tasmanian origin UTAS health graduates contribute to the state's health workforce after qualifying. Further research is needed to explore PPP over time and to understand why some graduates are motivated to seek employment on the Australian mainland and in particular, metropolitan cities.

Persistent COVID-19-associated neurocognitive symptoms in non-hospitalized patients.

As cases of coronavirus disease 2019 (COVID-19) mount worldwide, attention is needed on potential long-term neurologic impacts for the majority of patients who experience mild to moderate illness managed as outpatients. To date, there has not been discussion of persistent neurocognitive deficits in patients with milder COVID-19. We present two cases of non-hospitalized patients recovering from COVID-19 with persistent neurocognitive symptoms. Commonly used cognitive screens were normal, while more detailed testing revealed working memory and executive functioning deficits. An observational cohort study of individuals recovering from COVID-19 (14 or more days following symptom onset) identified that among the first 100 individuals enrolled, 14 were non-hospitalized patients reporting persistent cognitive issues. These 14 participants had a median age of 39 years (interquartile range: 35-56), and cognitive symptoms were present for at least a median of 98 days (interquartile range: 71-120 following acute COVID-19 symptoms); no participants with follow-up evaluation reported symptom resolution. We discuss potential mechanisms to be explored in future studies, including direct viral effects, indirect consequences of immune activation, and immune dysregulation causing auto-antibody production.

Barriers and enablers to skill-mix in the oral health workforce: A systematic review.

INTRODUCTION: In dentistry, the term "skill-mix" is used to describe the combinations of dentists and dental care professionals in delivering activities that are commonly established by their level of education, training and scope of practice. However, the literature has indicated an under-utilisation of skill-mix in the oral health care team. Further work is required to understand the poor uptake of skill-mix in oral health care and what could be done to address this issue. OBJECTIVE: To identify and synthesise the available evidence on the barriers and enablers to skill-mix in the oral health workforce using a macro-, meso- and micro-level framework. MATERIALS AND METHODS: The databases MEDLINE, CINAHL and Scopus between January 2010 to April 2020 were searched. Primary research studies published in English were included. RESULTS: Thirty-two articles were included. Key barriers and enablers at each level of analysis were identified. Macro-level barriers and enablers included structural, regulatory and policy conditions and dental health care needs of populations. Meso-level barriers and enablers defined the parameters of service delivery and included workplace characteristics, referral systems and patterns, and workplace productivity and efficiency. Micro-level barriers and enablers pertained to the perceptions, attitudes, and social acceptability of stakeholders that affected the delivery of services. CONCLUSION: Understanding the barriers and enablers from a multi-level framework requires further high-quality research to fully appreciate its importance in addressing health care needs within populations and increase generalisability to oral health settings.

Outcomes and costs of single-step hepatitis C testing in primary care, Birmingham, United Kingdom.

OBJECTIVES: In UK laboratories, the diagnostic algorithm for chronic hepatitis C (HCV) infection commonly requires two serological assays to confirm anti-HCV-antibody positivity in a serum sample followed by HCV RNA detection in a second whole-blood sample (two-step testing algorithm). A single-step algorithm (both anti-HCV antibodies and RNA tested on an initial serum specimen) has been advocated to reduce attrition rates from the care pathway. STUDY DESIGN: To investigate the feasibility, clinical impact and relative costs of switching from a two-step to single-step testing algorithm in the laboratory, a pilot study on unselected primary care requests was undertaken. METHODS: All primary care patients tested for HCV infection from December 2013 to April 2016 were included. The single-step testing algorithm was introduced in March 2015. Before this, the two-step algorithm was used. Patients were followed up until August 2016. RESULTS: RNA quantitation in plasma was within one log of serum values for 21 paired samples. Although all patients in the single-step algorithm received an RNA test, only 70% completed the two-step testing algorithm; differences in referral rates to specialist care was due to 30% of HCV antibody-positive patients in the two-step algorithm not having follow-up whole-blood sampling for HCV RNA testing. Costs per new diagnosis and new diagnosis referred to specialist care were lower in single-step testing by £94.32 and £144.25, respectively. CONCLUSION: This study provides further evidence that a single-step testing algorithm, as recommended in the UK Standards for Microbiology Investigation, works in practice and should be the standard of care for screening for chronic HCV.

Neighbourhoods and obesity: A prospective study of characteristics of the built environment and their association with adiposity outcomes in children in Montreal, Canada.

This paper examined prospective associations between built environment features assessed at baseline using direct audits and adiposity outcomes two years later in Montreal, Canada. Data stem from the Quebec Adipose and Lifestyle Investigation in Youth study of 630 children aged 8-10 years with a parental history of obesity. Baseline measurements took place between 2005 and 2008. Follow-up took place between 2008 and 2011. Built environment features were assessed at baseline in up to 10 contiguous street segments around participants' residential addresses using on-site audits. Analyses were restricted to participants who reported the same address both at baseline and follow-up. Prospective associations between adiposity outcomes at follow-up (BMI z-score and waist-height ratio) and built environment features at baseline (traffic-calming features, pedestrian aids, disorder, physical activity facilities, convenience stores, and fast-food restaurants) were examined using multivariable regression models. 391 children were included in the analyses. In fully-adjusted models, children living in residential areas with presence of pedestrian aids had lower BMI z-score, and lower waist-height ratio. Also, children residing in residential areas with at least one convenience store had lower BMI z-score, and lower waist-height ratio at follow-up. Findings provide evidence of the potential role of street-level urban design features in shaping childhood adiposity. To better inform policy and intervention, future research should explore the possibility of reducing obesogenic neighbourhoods by enhancing street-level design features.

The fall and rise of Group A Streptococcus diseases.

Streptococcus pyogenes (or Group A Streptococcus, GAS) is a Gram-positive human pathogen responsible for a diverse array of superficial, invasive and immune-related diseases. GAS infections have historically been diseases of poverty and overcrowding, and remain a significant problem in the developing world and in disadvantaged populations within developed countries. With improved living conditions and access to antibiotics, the rates of GAS diseases in developed societies have gradually declined during the 20th century. However, genetic changes in circulating GAS strains and/or changes in host susceptibility to infection can lead to dramatic increases in the rates of specific diseases. No situations exemplify this more than the global upsurge of invasive GAS disease that originated in the 1980s and the regional increases in scarlet fever in north-east Asia and the UK. In each case, increased disease rates have been associated with the emergence of new GAS strains with increased disease-causing capability. Global surveillance for new GAS strains with increased virulence is important and determining why certain populations suddenly become susceptible to circulating strains remains a research priority. Here, we overview the changing epidemiology of GAS infections and the genetic alterations that accompany the emergence of GAS strains with increased capacity to cause disease.

School food environments associated with adiposity in Canadian children.

BACKGROUND/OBJECTIVES: Targeting obesogenic features of children's environment that are amenable to change represents a promising strategy for health promotion. The school food environment, defined as the services and policies regarding nutrition and the availability of food in the school and surrounding neighborhood, is particularly important given that students travel through the school neighborhood almost daily and that they consume a substantial proportion of their calories at school. SUBJECTS/METHODS: As part of the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) cohort study, we assessed features of school indoor dietary environment and the surrounding school neighborhoods, when children were aged 8-10 years (2005-2008). School principals reported on food practices and policies within the schools. The density of convenience stores and fast-food outlets surrounding the school was computed using a Geographical Information System. Indicators of school neighborhood deprivation were derived from census data. Adiposity outcomes were measured in a clinical setting 2 years later, when participants were aged 10-12 years (2008-2011). We conducted cluster analyses to identify school food environment types. Associations between school types and adiposity were estimated in linear regression models. RESULTS: Cluster analysis identified three school types with distinct food environments. Schools were characterized as: overall healthful (45%); a healthful food environment in the surrounding neighborhood, but an unhealthful indoor food environment (22%); or overall unhealthful (33%). Less healthful schools were located in more deprived neighborhoods and were associated with greater child adiposity. CONCLUSIONS: Despite regulatory efforts to improve school food environments, there is substantial inequity in dietary environments across schools. Ensuring healthful indoor and outdoor food environments across schools should be included in comprehensive efforts to reduce obesity-related health disparities.

Weekday and weekend food advertising varies on children's television in the USA but persuasive techniques and unhealthy items still dominate.

OBJECTIVE: In 2006, food industry self-regulatory efforts aimed to balance the mix of food advertisements to limit children's exposure to unhealthy food products. An update to these efforts proposed to eliminate all unhealthy advertisements during peak child viewing times and implement uniform nutrition criteria by December, 2013. Marketing techniques are not currently addressed in self-regulatory efforts. The food industry's pledge prompted researchers to conduct a content analysis to assess nutritional quality and presence of persuasive marketing techniques in child-directed food and beverage advertisements. STUDY DESIGN: Content analysis. METHODS: 32 h of children's television programming were recorded in February, 2013. Three independent coders assessed the nutritional content of food and beverage advertisements using the UK Nutrition Profiling System and assessed presence of persuasive techniques (PTs) using a rating form developed for this study. RESULTS: Overall, 13.75% of advertisements promoted a food or beverage product. Most food advertisements, 54.6%, represented unhealthy products and 95.48% of food advertisements contained at least one PT. The number of PTs was not significantly different for healthy (M = 4.98, SD = 2.07) and unhealthy food advertisements (M = 4.66, SD = 1.82) however food advertisements aimed at children used significantly more PTs (M = 5.5, SD = 1.43) than those targeting adults (M = 1.52, SD = 1.54), t (153) = 11.738, P < 0.0001. Saturday morning children's programming showed significantly fewer food advertisements compared to weekday morning children's programming. CONCLUSIONS: While a majority of food-related advertisements represented unhealthy items, advertisements airing during Saturday morning programming featured fewer food advertisements overall and were more frequently for healthier items compared to weekdays. Industry self-regulation may not be effective for reducing overall unhealthy ad exposure but may play a role in reduced exposure on weekends. Despite policy efforts, additional changes are needed to improve ad exposure experienced by children with a focus on addressing the persistent use of persuasive marketing techniques in food advertising intended for children.

Hookah smoking behavior initiation in the context of Millennials.

OBJECTIVES: This study aims to examine current hookah users' perceptions, attitudes, and normative beliefs regarding hookah smoking to further elucidate the rise in hookah smoking prevalence among young adults (aged 18-24 years) and reveal why hookah smoking is perceived as less harmful than other forms of tobacco consumption. STUDY DESIGN: Qualitative. METHODS: Data from six focus group interviews with hookah smokers aged between 18 and 24 years were analyzed using a grounded theory approach. Focus groups were evenly split between frequent and infrequent hookah users, and were predominantly composed of college students, with two groups of hookah users consisting of 18-24 year olds of non-student status. RESULTS: Hookah users shared a much larger set of positive hookah smoking behavioral beliefs as opposed to negative behavioral beliefs. Generational traits served as the overarching commonality among the behavior performance initiation determinants observed. The most notable generational trends observed were within the cultural category, which included the following millennial characteristics: autonomy, personalization, novelty appeal, convenience, globally oriented, entertainment, collaboration, health conscious, and valuing their social network. CONCLUSIONS: Millennial hookah users revealed mindfulness regarding both potential negative and positive reasons stemming from continued hookah use; however, behavioral beliefs were primarily fixated on the perception that hookah smoking was a healthier alternative to cigarette smoking. Future implications for this study's findings include generating more positive ways to express these traits for young adults; policy implications include raising hookah bar age limits, implementing indoor smoking restrictions, and limiting the ease of accessibility for purchasing hookah supplies.

Independent associations between child and parent perceived neighborhood safety, child screen time, physical activity and BMI: a structural equation modeling approach.

OBJECTIVE: The main objective of this study was to investigate whether children's perceptions of neighborhood safety are associated with their weight status and weight-related behaviors, independently of their parents' perceptions. METHODS: Data were from the baseline wave (collected in 2005-2008) of the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY), an ongoing prospective study of 630 children aged 8-10 years (from Quebec, Canada) at risk of obesity. Weight and height were measured, and World Health Organization age- and sex-specific body mass index (BMI) z-scores were computed. Physical activity was measured by accelerometry, and time spent watching television, playing computer and video games during week and weekend days was self-reported. Structural equation modeling was used to simultaneously estimate the associations between parent and child perceived safety, with children's BMI z-score, physical activity and screen time. RESULTS: The results suggest that, when parent perceived safety was at the mean, children who perceived their neighborhood as being safest had nearly an additional 70 daily activity counts per minute (representing an ~10% increase in overall physical activity level) compared with children who perceived it as being least safe. Among children who perceived a mean level of safety, those whose parents perceived their neighborhood as being safest spent approximately an hour less per day in front of screens compared with those whose parents perceived their neighborhood as being least safe. Parent and child perceptions of safety both indirectly contribute to children's weight status by differentially impacting weight-related behaviors. CONCLUSION: Findings indicate that targeting both parent and child perceived neighborhood safety could bolster efforts to promote healthy weight and weight-related behaviors among children.

Poor health among smokers obtaining colonoscopy screening: making the case for cessation intervention.

OBJECTIVES: Assess differences in perceived health status among individuals receiving colonoscopy screening based on smoking status. STUDY DESIGN: Cross-sectional data were collected as part of a larger study investigating whether verbal and non-verbal communication and behaviors of gastroenterologists and nurses. METHOD: Data for this study were collected between 2011 and 2013 among receiving colonoscopy screenings. Data were collected as part of a study assessing patients (n = 1785) undergoing colonoscopy screenings about their expectations, concerns, understanding of the procedure, and perceived health status. Differences between current, former and never smokers were analyzed using a one-way between subjects ANOVA, with a Scheffe post hoc. RESULTS: Post hoc analyses revealed that current smokers were significantly different from former or never smokers on the following variables: days their physical health was not good, days their mental health was not good, days health influenced their activities, days pain influenced their ability to perform activities, perceived general health, and current anxiety. CONCLUSION: This study looked at perceived health among individuals receiving colonoscopy screening by on smoking status, a relevant population based on the recent Surgeon Generals link. Former smokers reported similar health status across all variables as never smokers, suggesting the effect of quitting smoking on self-perceived health. With this link, tailored smoking cessation messages to smokers receiving colonoscopy screenings may be an excellent vantage point for a smoking cessation intervention.

Utilisation of oral health services provided by non-dental health practitioners in developed countries: a review of the literature.

OBJECTIVE: People who have limited access to dental care may present to non-dental health practitioners for dental treatment and advice. This review synthesised the available evidence regarding the use of non-dental health practitioners for oral health problems and the services provided by non-dental health practitioners to manage such presentations. METHODS: PubMed and CINAHL databases were searched using key search terms to identify all relevant quantitative and qualitative English-language studies published between 1990 and March 2014. Snowballing techniques were then applied whereby the reference lists of retrieved articles were searched for other relevant citations. Grey literature was searched via Google using the same search terms to identify unpublished work and government reports. RESULTS: Of the 43 papers which met the review criteria, 25 papers reported on the use of non-dental health practitioners for oral health problems and 18 on dental care education and training for non-dental health practitioners. Four reports were located from the grey literature on the involvement of non-dental health practitioners in the management of oral health care. CONCLUSIONS: The review of literature showed that both children and adults utilise non-dental health practitioners for oral health problems. Despite this, Emergency Department medical staff, medical practitioners and pharmacists generally lacked training and knowledge in the maragement of oral health. Services from non-dental health practitioners mainly focussed on children. The literature on education and training for non-dental health practitioners was limited.

Neighborhood built and social environment characteristics: a multilevel analysis of associations with obesity among children and their parents.

OBJECTIVE: To examine associations between characteristics of neighborhood built and social environments and likelihood of obesity among family triads living at the same residential address and to explore whether these associations differ between family members. METHODS: Data were from the baseline wave of QUALITY (Quebec Adipose and Lifestyle Investigation in Youth), an ongoing study on the natural history of obesity in 630 Quebec youth aged 8-10 years with a parental history of obesity. Weight and height were measured in children and both biological parents and body mass index was computed. Residential neighborhood environments were characterized using a Geographic Information System and in-person neighborhood audits. Principal components analysis allowed for identification of overarching neighborhood indicators including poverty, prestige, level of urbanicity, traffic, physical disorder and deterioration, and pedestrian friendliness. Multilevel logistic regressions were used to examine associations between neighborhood indicators and obesity within multiple family members residing at the same address while controlling for household-level sociodemographic variables. RESULTS: A total of 417 families were included in the analysis. Families residing in lower and average prestige neighborhoods were more likely to be obese (odds ratio (OR)=1.69, 95% confidence interval (CI): 1.16, 2.44, and OR=1.51, 95% CI: 1.09, 2.11, respectively) than those residing in higher prestige neighborhoods. Residing in lower traffic neighborhoods was associated with less obesity (OR=0.69, 95% CI: 0.50, 0.95). Other neighborhood indicators may have differential effects across family members. For example, as neighborhood poverty increased, obesity was more likely among children but less likely among fathers and no different for mothers. CONCLUSION: Findings indicate that some shared neighborhood exposures are associated with greater risk of obesity for entire families whereas other exposures may heighten obesity risk in some but not all family members. Patterns may reflect differences in the way in which family members use residential neighborhood environments.

Incorporating model quality information in climate change detection and attribution studies.

In a recent multimodel detection and attribution (D&A) study using the pooled results from 22 different climate models, the simulated "fingerprint" pattern of anthropogenically caused changes in water vapor was identifiable with high statistical confidence in satellite data. Each model received equal weight in the D&A analysis, despite large differences in the skill with which they simulate key aspects of observed climate. Here, we examine whether water vapor D&A results are sensitive to model quality. The "top 10" and "bottom 10" models are selected with three different sets of skill measures and two different ranking approaches. The entire D&A analysis is then repeated with each of these different sets of more or less skillful models. Our performance metrics include the ability to simulate the mean state, the annual cycle, and the variability associated with El Niño. We find that estimates of an anthropogenic water vapor fingerprint are insensitive to current model uncertainties, and are governed by basic physical processes that are well-represented in climate models. Because the fingerprint is both robust to current model uncertainties and dissimilar to the dominant noise patterns, our ability to identify an anthropogenic influence on observed multidecadal changes in water vapor is not affected by "screening" based on model quality.

Potential impacts of a warming climate on water availability in snow-dominated regions.

All currently available climate models predict a near-surface warming trend under the influence of rising levels of greenhouse gases in the atmosphere. In addition to the direct effects on climate--for example, on the frequency of heatwaves--this increase in surface temperatures has important consequences for the hydrological cycle, particularly in regions where water supply is currently dominated by melting snow or ice. In a warmer world, less winter precipitation falls as snow and the melting of winter snow occurs earlier in spring. Even without any changes in precipitation intensity, both of these effects lead to a shift in peak river runoff to winter and early spring, away from summer and autumn when demand is highest. Where storage capacities are not sufficient, much of the winter runoff will immediately be lost to the oceans. With more than one-sixth of the Earth's population relying on glaciers and seasonal snow packs for their water supply, the consequences of these hydrological changes for future water availability--predicted with high confidence and already diagnosed in some regions--are likely to be severe.

Difference in patterns of prescribing antidepressants known for their weight-modulating and cardiovascular side effects for patients with obesity compared to patients with normal weight.

BACKGROUND: Patients with depression and comorbid obesity may be more prone to weight modulating and cardiovascular side effects of selected antidepressants (AD). It is important to ascertain whether these AD prescriptions differ by patient weight status. METHODS: Canadian Primary Care Sentinel Surveillance Network (CPCSSN) electronic medical records were used. Participants were adults with depression prescribed an AD in 2000-2016, with weight categories established before the first prescription. Logistic regression and mixed effects models were applied to examine associations between obesity and AD prescribing, adjusted for sex, age, and comorbidities. Machine learning algorithm random forest (RF) was used to evaluate the importance of weight in predicting prescribing patterns. RESULTS: Of 26,571 participants, 72.4% were women, mean age was 38.9 years (standard deviation (SD)=14.2) and mean BMI 27.0 kg/m2 (SD = 6.5); 9.5% had ≥ 1 comorbidity. Patients with obesity, compared to normal weight patients, were more likely to receive bupropion (adjusted odds ratio (aOR) 1.24, 95%CI: 1.09,1.42), fluoxetine (aOR 1.14, 95%CI: 0.97,1.34), and amitriptyline (aOR 1.13, 95%CI: 0.93,1.36), and less likely to receive mirtazapine (aOR 0.55, 95%CI: 0.44,0.68) and escitalopram (aOR 0.88, 95%CI: 0.80, 0.97). RF analysis showed that weight was among the most important predictors of prescribing patterns, equivalent to age and more important than sex. CONCLUSIONS: AD prescribing patterns for patients with obesity appear to be different for selected AD types, including AD known for their weight-modulating and cardiovascular side effects. Longitudinal studies are needed to examine whether these prescribing patterns are associated with significant health outcomes.

Simulated and observed variability in ocean temperature and heat content.

Observations show both a pronounced increase in ocean heat content (OHC) over the second half of the 20th century and substantial OHC variability on interannual-to-decadal time scales. Although climate models are able to simulate overall changes in OHC, they are generally thought to underestimate the amplitude of OHC variability. Using simulations of 20th century climate performed with 13 numerical models, we demonstrate that the apparent discrepancy between modeled and observed variability is largely explained by accounting for changes in observational coverage and instrumentation and by including the effects of volcanic eruptions. Our work does not support the recent claim that the 0- to 700-m layer of the global ocean experienced a substantial OHC decrease over the 2003 to 2005 time period. We show that the 2003-2005 cooling is largely an artifact of a systematic change in the observing system, with the deployment of Argo floats reducing a warm bias in the original observing system.

A critical review of the nursing shortage in Malaysia.

OBJECTIVE: This paper describes and critically reviews steps taken to address the nursing workforce shortage in Malaysia. BACKGROUND: To address the shortage and to build health care capacity, Malaysia has more than doubled its nursing workforce over the past decade, primarily through an increase in the domestic supply of new graduates. METHODS: Government reports, policy documents and ministerial statements were sourced from the Ministry of Health Malaysia website and reviewed and analysed in the context of the scholarly literature published about the health care workforce in Malaysia and more generally about the global nursing shortage. RESULTS: An escalation in student numbers and the unprecedented number of new graduates entering the workforce has been associated with other impacts that have been responded to symptomatically rather than through workplace reform. Whilst growing the domestic supply of nurses is a critical key strategy to address workforce shortages, steps should also be taken to address structural and other problems of the workplace to support both new graduates and the retention of more experienced staff. CONCLUSION: Nursing shortages should not be tackled by increasing the supply of new graduates alone. The creation of a safe and supportive work environment is important to the long-term success of current measures taken to grow the workforce and retain nurses within the Malaysian health care system.

Body image and C-reactive protein in adolescents.

BACKGROUND: The association between inflammation and obesity is well documented; however, there is little evidence linking physiological markers of inflammation and psychosocial factors such as body image. This study examined the relation between body image and C-reactive protein (CRP). METHODS: Data were available for 1503 adolescents aged 13 and 16 years in a province-wide survey of a representative sample of youth in Quebec, Canada. Participants completed questionnaires assessing body image indicators of social pressures to lose weight and personal body shape discrepancies, provided a fasting blood sample for CRP, and had height and weight measured. RESULTS: In separate multivariable logistic regression models for girls and boys, body shape discrepancy was positively associated with CRP (boys: OR=2.6, 95% CI=1.4-4.8; girls: OR=2.2, 95% CI=1.2-4.3) independent of body mass index, puberty status and socio-demographic variables. CONCLUSIONS: Adverse biological markers of cardiometabolic risk and negative body image are associated in adolescence. These findings suggest that, in addition to the well-known psychological problems, negative body image perceptions may also threaten adolescent's physical health.