University of Papua New Guinea

Across the globe there is a need to increase the number of midwives and invest in developing the capacity of midwives.

There is evidence that the promotion of midwifery leadership can lead to an improvement in maternal and newborn health. The Papua New Guinea (PNG) Midwifery Buddy Program develops a partnership between Australian and PNG midwives with the goal of building leadership confidence and skills in participants.

To explore participants' perception of the Buddy Program and the impact that participation in the Program had on their leadership skills.

This study utilised a multi-method approach, where data were collected through surveys conducted on multiple time points throughout the Buddy Program. All participants in the Program were invited to participate. Self-Leadership, Confidence as a Leader, Behaviour as a leader, and perceptions on the program workshop were assessed. Within and between group comparisons were made at baseline, after the workshop and 6-months.

The program was completed by 12 midwives from PNG and 7 from Australia. From baseline to 6-months, there was a significant increase in self-leadership skills (p= 0.016) in the PNG midwives. There was no significant difference between the Australian and PNG midwives for Self-Leadership, Confidence as a Leader or Behaviour as a leader at any time point.

Participation in the Program allowed midwives to develop their leadership skills and midwives valued the opportunity to network with other midwives.

The Buddy Program could be a model applied across other countries to build the capacity of midwives.

School-age children and adolescents may be at risk of anemia through demands on micronutrients required for growth and maturation.

This multicountry analysis examined the burden of anemia in children aged 5-19 y by sex and age category and associations with micronutrient deficiencies, inflammation, and BMI.

Children aged 5-19 y from surveys in the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) Project were included with hemoglobin, ≥1 micronutrient (iron, vitamin A, folate, vitamin B₁₂, or zinc) and inflammation biomarker, and n > 100 per survey. Factors with bivariate relationships with anemia (P < 0.1) were included in multivariable modified Poisson regression models to examine the attributable burden of anemia.

This analysis included 54,534 children from 17 surveys in 16 countries (16 surveys for 15-19 y; 9 surveys for 10-14 y; 8 surveys for 5-9 y). Median overall anemia prevalence was 16% (range: 5% in Ecuador, United Kingdom, and United States to 59% in Côte d'Ivoire) with the highest burden in 15-19-y-old females (24%). In most surveys, anemia prevalence did not differ by sex for children aged 5-14 y, and median anemia prevalence was lower in children aged 10-14 y (7%) than in those aged 5-9 y (9%) or 15-19 y (22%). In most surveys, higher anemia prevalence was associated (P < 0.05) with iron deficiency (15%) [prevalence ratio (PR): 1.6-14.2; 5-9 y, 4/7 surveys; 10-14 y, 6/6 surveys; 15-19 y, 13/14 surveys), vitamin A deficiency (2%) (PR: 1.8-3.0; 5-9 y, 2/2 surveys; 10-14 y, 2/3 surveys; 15-19 y, 2/3 surveys), and inflammation (13%) (PR: 1.4-2.4: 5-9 y, 4/4 surveys; 10-14 y, 2/4 surveys; 15-19 y, 6/8 surveys). Folate, vitamin B₁₂, zinc, and BMI had weak, variable associations with anemia.

Iron deficiency and vitamin A deficiency are consistently associated with anemia in school-age children and adolescents, whereas inflammation and other micronutrients had context-dependent associations. This research underscores the importance of examining multiple micronutrients associated with anemia in the context of factors such as country, age, and sex.

Chimeric antigen receptor (CAR) T cell therapy is a promising form of adoptive cell therapy. This process re-engineers patient-derived T cells to express a hybrid receptor targeting a selected tumour-expressed antigen. CAR T cell therapy directed against the CD19 antigen has been highly successful in haematological malignancies that have failed other therapies, particularly relapsed B-cell acute lymphoblastic leukaemia (B-ALL). This review focuses on the numerous real-world aspects of treating children with B-ALL with CD19-targeted CAR T cell therapy. We discuss some of the considerations for clinicians including manufacturing time, administration and care of the patient receiving this novel therapy, toxicities and outcomes. We also discuss the therapeutic uncertainty many physicians now face of when to use CAR T cell therapy in the patient journey, especially when haematopoietic stem cell transplant is being considered.