Psycho-educational group intervention for family caregivers of hospitalized palliative care patients:pilot study

Family caregivers of patients requiring palliative care commonly experience physical, social, and psychological burdens. Although family caregivers are acknowledged as valid service recipients of palliative care, many have unmet needs, and systematic reviews have shown there are limited evidence-based supportive interventions.

Trades Unions and the Transition away from 'actually existing unsustainability':From economic crisis to a new political economy beyond growth

Traditionally trades unions have accepted and promoted orthodox economic growth as a policy imperative. In recent years there has been a noticeable ‘greening’ of trade unions in relation to initiatives such as the ‘Green new deal’ and the creation of ‘green collar’ employment and the focus on a ‘just transition’ to a low carbon economy. Yet given the growing evidence of the negative impacts of economic growth in terms of environmental, resource and pollution impacts as well as the inability of economic growth to tackle (as opposed to managed) socio-economic inequality, it is timely to review the case for trades unions to fundamentally rethink the commitment to orthodox economic growth. That is, for trades unions to consider going beyond their current ‘green/sustainability’ strategies to consider more radical ‘post-growth’ policy positions. This chapter will explore some of the dimensions of a ‘post-growth’ trade union agenda by considering the evidence for going beyond growth from within the trade union movement (specifically looking at the International Labor Organization’s 2004 report on Economic Security, to internal union discussions around trades unionism and climate change) and external evidence ranging from Wilkinson and Pickett’s The Spirit Level (which suggests amongst other things that in the developed world what is needed is not economic growth but greater redistribution and lowering inequality – issues also of traditional interest to the Trades Union movement) to Tim Jackson’s Prosperity without Growth (which suggests that economic growth is ecologically unsustainable as well having passed a threshold beyond which it is contributing to human well-being in the developed world). As well as discussing the relationship between trades unionism and what may be called ‘green political economy’ (such as the ‘degrowth’ and ‘limits to growth’ perspectives) this chapter will also discuss the practical/policy implications of this ‘post-growth’ perspective in relation to trades unionism’s analysis of capitalism and its transformation in the context of a climate changed, carbon constrained world, including implications for ideas such as basic income, a shorter working week and what a trades unionism focused on how to achieve high quality of life within a low carbon context might look like.

Effect of a multifaceted intervention on adherence to hand hygiene among healthcare workers:A cluster-randomized trial

OBJECTIVES. Adherence to hand hygiene among healthcare workers (HCWs) is widely believed to be a key factor in reducing the spread of healthcare-associated infection. The objective of this study was to evaluate the impact of a multifaceted intervention to increase rates of adherence to hand hygiene among HCWs and to assess the effect on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) colonization. DESIGN. Cluster-randomized controlled trial. SETTING. Thirty hospital units in 3 tertiary care hospitals in Hamilton, Ontario, Canada. INTERVENTION. After a 3-month baseline period of data collection, 15 units were randomly assigned to the intervention arm (with performance feedback, small-group teaching seminars, and posters) and 15 units to usual practice. Hand hygiene was observed during randomly selected 15-minute periods on each unit, and the incidence of MRSA colonization was measured using weekly surveillance specimens from June 2007 through May 2008. RESULTS. We found that 3,812 (48.2%) of 7,901 opportunities for hand hygiene in the intervention group resulted in adherence, compared with 3,205 (42.6%) of 7,526 opportunities in the control group (P <.001; independent t test). There was no reduction in the incidence of hospital-acquired MRSA colonization in the intervention group. CONCLUSION. Among HCWs in Ontario tertiary care hospitals, the rate of adherence to hand hygiene had a statistically significant increase of 6% with a multifaceted intervention, but the incidence of MRSA colonization was not reduced.

Interlocking directorates and conflicts of interest: The Rotterdamsche Bankvereeniging, Müller & Co. and the Dutch financial crisis of the 1920s

How can interlocking directorates cause financial instability for universal banks? A detailed history of the Rotterdamsche Bankvereeninging in the 1920s answers this question in a case study. This large commercial bank adopted a new German-style universal banking business model from the early 1910s, sharing directors with the firms it financed as a means of controlling its interests. Then, in 1924, it required assistance from the Dutch state in order to survive a bank run brought on by public concerns over its close ties with Müller & Co., a trading conglomerate that suffered badly in the economic downturn of the early 1920s. Using a new narrative history combined with an interpretive model, this article shows how the interlocking directorates between the bank and this major client, and in particular the direction of influence of these interlocks, resulted in a conflict of interest that could not be easily overcome.

Managing state-owned enterprises in an age of crisis:An analysis of irish experience

As with all aspects of public management, the control, financing, and regulation of state-owned enterprises (SOEs) are matters subject to changing international trends and domestic political imperatives. The effects of the global financial crisis (GFC) on the ownership, financing, and role of SOEs are still unfolding, but undoubtedly will be heavily influenced by a new era of public sector reforms principally designed to reassert central political controls, as well as by fiscal pressures to balance state budgets. In this regard, the Irish experience is instructive, with the findings from two datasets being used here to examine various modes of state enterprise control and their corresponding autonomy. Significantly, there has been considerable variety within and across the SOE sector, demonstrating the need for more detailed understanding of how SOEs are managed. © 2011 Taylor & Francis.

Identifying Economically Vulnerable Groups as the Economic Crisis Emerged

A frequent refrain during recent debates on welfare cuts and tax increases has related to the need to "protect the vulnerable". However, it is far from clear that a consensus exists on which individuals or groups are to be included under this heading with a consequent lack of clarity for the policy implications of pursuing this goal. In this paper, operating with a conception of social exclusion that incorporates notions of dynamics and multidimensionality, we make use of EU-SILC 2008 data for Ireland to clarify the distinction between income poverty and economic vulnerability. We then proceed to consider the relationship between these outcomes and multiple deprivation, financial pressures and perceptions of recent and future economic prospects. Our analysis is then extended to compare patterns of risk for poverty and vulnerability in relation to key socio-economic groups. Finally, we will consider the relationship between poverty and vulnerability and the distribution of welfare dependence. Our analysis suggests that the vulnerable but non-poor group may need to be a key focus of policy attention in the future.

The rebirth of dependence– offering an alternative understanding of the financial crisis

Purpose – This article aims to contribute to the re-evaluation of the global market system using a Marxist inspired theory of development, dependency.

Design/methodology/approach – This article draws on dependency theory as an alternative means of understanding global relationships. Building on existing literature, it modifies dependency to encapsulate technological developments and trends in the global market.

Findings – Re-evaluating the global market and the relationships that underpin it, through an alternative theory, highlights the fragility of markets and associated relationships. Increasingly, nation states are becoming irrelevant. This presents a problem as the main actors in the global market today are “above” inter-state relations, yet the organs that regulate their behaviour still are grounded in inter-state rhetoric. The relationship between development and underdevelopment remains.

Research limitations/implications – The financial crisis has propagated a wealth of interest in the relationships between states, between multi-national corporations (MNCs) and between MNCs and state. Using this broad theory of modified dependency, it can be applied to a range of different relationships. In the wake of financial crisis, there is the opportunity to raise awareness of these ingrained issues and initiate discussions at national, regional and international levels to alleviate some of the conditions of dependence.

Practical implications – Regardless of the work of national governments and NGOs to instigate development in lesser-developed regions through policy and regulations, unless there is a conscientious commitment from MNCs operating in that region to contribute to development, the result will be the development of underdevelopment and the underdevelopment of development. CSR can help alleviate the conditions of the dependence on capital generated by MNCs, but this is not a solution to an ingrained problem, capitalism.

Originality/value – This article introduces a modified theory of dependency for the first time. It applies the theory to the financial crisis and to the continent of Africa. It considers the role that CSR can play in alleviating the conditions of dependence.

Responding to crisis: When the telephone fails

The world is changing. Advances in telecommunications have meant that the world is shrinking – data can be moved across continents in the time it takes to send an email or access the cloud. Although developments such as these highlight the extent of scientific and technological evolution, in terms of legal liability, questions must be asked as to the capacity of our legal structures to evolve accordingly.

This article looks at how emergency telephone provision and any shift to VoIP systems might fit with existing tort liability and associated duty implications. It does so by analysing the technology through the principles that signpost UK tort law. This article recognises that as an emerging area, the legal liability implications have not yet been discussed in any great detail. The aim of this article therefore is to introduce the area, encourage debate and consider the issues that may become increasingly relevant as these types of technologies become industrial standards.

Fumonisin B-1 as a Urinary Biomarker of Exposure in a Maize Intervention Study Among South African Subsistence Farmers

Background: The consumption of maize highly contaminated with carcinogenic fumonisins has been linked to high oesophageal cancer rates. The aim of this study was to validate a urinary fumonisin B-1 (UFB1) biomarker as a measure of fumonisin exposure and to investigate the reduction in exposure following a simple and culturally acceptable intervention.

Methods: At baseline home-grown maize, maize-based porridge, and first-void urine samples were collected from female participants (n = 22), following their traditional food practices in Centane, South Africa. During intervention the participants were trained to recognize and remove visibly infected kernels, and to wash the remaining kernels. Participants consumed the porridge prepared from the sorted and washed maize on each day of the two-day intervention. Porridge, maize, and urine samples were collected for FB1 analyses.

Results: The geometric mean (95% confidence interval) for FB1 exposure based on porridge (dry weight) consumption at baseline and following intervention was 4.84 (2.87-8.14) and 1.87 (1.40-2.51) mg FB1/kg body weight/day, respectively, (62% reduction, P < 0.05). UFB1C, UFB1 normalized for creatinine, was reduced from 470 (295-750) at baseline to 279 (202-386) pg/mg creatinine following intervention (41% reduction, P = 0.06). The UFB1C biomarker was positively correlated with FB1 intake at the individual level (r - 0.4972, P < 0.01). Urinary excretion of FB1 was estimated to be 0.075% (0.054%-0.104%) of the FB1 intake.

Conclusion: UFB1 reflects individual FB1 exposure and thus represents a valuable biomarker for future fumonisin risk assessment.

Impact: The simple intervention method, hand sorting and washing, could positively impact on food safety and health in communities exposed to fumonisins. Cancer Epidemiol Biomarkers Prev; 20(3); 483-9. (C)2011 AACR.

Simple intervention method to reduce fumonisin exposure in a subsistence maize-farming community in South Africa

In the Centane magisterial area of South Africa, high rates of oesophageal cancer have been associated with home-grown maize contaminated with fumonisins. The aim of this study was to implement a simple intervention method to reduce fumonisin exposure in a subsistence-farming community. The hand-sorting and washing procedures, based on traditional maize-based food preparation practices, were previously customised under laboratory-controlled conditions. Home-grown maize and maize-based porridge collected at baseline were analysed for fumonisin B1, B2 and B3. The geometric mean (95% confidence interval) of fumonisin contamination in the home-grown maize at baseline was 1.67 (1.21-2.32) mg kg-1 and 1.24 (0.75-2.04) mg kg -1 (dry weight) in the porridge. Fumonisin exposure was based on individual stiff porridge consumption and the specific fumonisin levels in the porridge (dry weight) consumed. Porridge (dry weight) consumption at baseline was 0.34 kg day-1 and fumonisin exposure was 6.73 (3.90-11.6) mu g kg-1 body weight day-1. Female participants (n = 22) were trained to recognise and remove visibly infected/damaged kernels and to wash the remaining maize kernels. The discarded kernels represented 3.9% by weight and the fumonisins varied from 17.1 to 76.9 mg kg-1. The customised hand-sorting and washing procedures reduced fumonisin contamination in the maize and porridge by 84 and 65%, respectively. The intervention reduced fumonisin exposure by 62% to 2.55 (1.94-3.35) mu g kg-1 body weight day-1. This simple intervention method has the potential to improve food safety and health in subsistence-farming communities consuming fumonisin-contaminated maize as their staple diet.

Reduction in exposure to carcinogenic aflatoxins by postharvest intervention measures in west Africa: a community-based intervention study

Background Aflatoxins are fungal metabolites that frequently contaminate staple foods in much of sub-Saharan Africa, and are associated with increased risk of liver cancer and impaired growth in young children. We aimed to assess whether postharvest measures to restrict aflatoxin contamination of groundnut crops could reduce exposure in west African villages.

Methods We undertook an intervention study at subsistence farms in the lower Kindia region of Guinea. Farms from 20 villages were included, ten of which implemented a package of postharvest measures to restrict aflatoxin contamination of the groundnut crop; ten controls followed usual postharvest practices. We measured the concentrations of blood aflatoxin-albumin adducts from 600 people immediately after harvest and at 3 months and 5 months postharvest to monitor the effectiveness of the intervention.

Findings In control villages mean aflatoxin-albumin concentration increased postharvest (from 5.5 pg/mg [95% CI 4.7-6.1] immediately after harvest to 18.7 pg/mg [17.0-20.6] 5 months later). By contrast, mean aflatoxin-albumin concentration in intervention villages after 5 months of groundnut storage was much the same as that immediately postharvest (7.2 pg/mg [6.2-8.4] vs 8.0 pg/mg [7.0-9.2]). At 5 months, mean adduct concentration in intervention villages was less than 50% of that in control villages (8.0 pg/mg [7.2-9.2] vs 18.7 pg/mg [17.0-20.6], p<0.0001). About a third of the number of people had non-detectable aflatoxin-albumin concentrations at harvest. At 5 months, five (2%) people in the control villages had non-detectable adduct concentrations compared with 47 (20%) of those in the intervention group (p<0.0001). Mean concentrations of aflatoxin B1 in groundnuts in household stores in intervention and control villages were consistent with measurements of aflatoxin-albumin adducts.

Interpretation Use of low-technology approaches at the subsistence-farm level in sub-Saharan Africa could substantially reduce the disease burden caused by aflatoxin exposure.