Research Review: Teenage pregnancy and parenthood: the role of fathers

From the research available in America and Britain it would appear that the men who father children by teenage mothers tend to be a few years older than their teenage partners, although a minority may be significantly older. With regard to the factors associated with fatherhood there are striking similarities to the literature on teenage mothers. Like teenage mothers young fathers tend to be from low socio-economic backgrounds, experience lower educational attainment and fewer employment opportunities than their childless peers. Similarly they tend to experience greater psychological and emotional difficulties and may have a history of delinquent behaviour.

These young fathers are involved in a variety of relationships with teenage mothers, few of which result in marriage and many of which result in the breakdown of cohabitation or the termination of the relationship. This pattern of increasing relationship breakdown over time is related to decreasing paternal contact with children in both America and Britain. Often conflictual relationships with teenage mothers or maternal grandparents and a lack of financial resources are cited by young fathers as barriers to their continued involvement and contact with their children. However, the mothers are much more likely to cite paternal disinterest as the reason for a lack of paternal involvement and there is some indication that mothers and fathers have different views on the level of practical involvement expected from fathers. While most of quantitative data on the subject provides a rather negative picture of paternal involvement, qualitative research highlights how many young fathers genuinely want to be involved with their children and would have more contact and input if they could.

While much less is known about the support provided to young fathers in comparison with their female counterparts, there is some suggestion that the support and role expectations provided by the paternal grandmother may influence how involved young fathers are. There is also some indication that a sizeable minority of young men may receive no such support from their family and may also be treated with hostility or ignored by the maternal grandparents. Young fathers also report limited or no contact with midwives, health visitors and social workers.

An Gaelaras, by O'Donnell and Tuomey:The Building blocks of Language: Review by Rick LeVert and Tarla MacGabhann

The opening of An Gaelaras - the Irish language cultural centre in Derry designed by O'Donnell + Tuomey - is the most significant architectural addition to the symbolic landscape of the Walled City in recent times. It marks nothing less than a physical re-surfacing and a normalisation of the Irish language in this long fragmented city. This alone places An Gaelaras in a delicate historical arc that spans over 1500 years of architectural heritage and links it with the now invisible ruins of St Columba's original 6th century monastery.

Oil and Dependency::The Case of Kazakhstan

Following the collapse of the Soviet Union in 1991, the newly independent oil-rich country of Kazakhstan has become a major recipient of foreign direct investment (FDI). Although international organisations such as the IMF and UNCTAD have claimed that FDI could be considered an engine in the transition from state socialism and as a powerful force for integration of this region into the global economy; this investment also poses significant risks to Kazakhstan. These risks fall into two broad categories: The first category can be broadly described as issues associated with the “resource curse” or the “Dutch Disease”. The term Dutch Disease describes a situation where booming demand in oil exporting countries, due to high oil revenues, leads to shift of an economy’s productive resources from the tradeable sector to the non-tradeable sector. The second category is associated with the over-dependency of oil exporting countries on a relatively small number of large multinational corporations (MNCs). This over-dependency can lead to a situation where licenses and concessions are granted at less favourable conditions than if they were auctioned in an efficient market. Examining the licensing policy of the Kazakhstani Energy and Mineral Resource Ministry, this paper notes that the latter issue of over-dependency has become less of a risk due to deliberate efforts to diversify investment relationships. Notwithstanding this situation there is some evidence that it remains difficult for oil exporting nations such as Kazakhstan to ensure that oil revenues are channelled into sustainable economic development.

Calvinist Absolutism: Archbishop James Ussher and Royal Power

Archbishop James Ussher's manuscript notebooks allow us to observe the making of a Calvinist absolutist and to orientate the archbishop's beliefs about royal power within European Reformed thought as a whole. By 1643, Ussher was preaching a polished and complete theory of absolute royal power, and it is possible to track the development of this political theory forward from his undergraduate days in the 1590s. Throughout his life Ussher engaged anxiously with Reformed theologians abroad, who generally favored limited rather than absolute monarchy. Nevertheless, Ussher shared with these Reformed colleagues both an antipathy to aspects of Aristotelian politics and a commitment to the divine institution of royal power. Finally, despite Ussher's hostility to Laudian innovations in the Irish Church, his heartfelt political beliefs made him a firm supporter of Stuart absolutism throughout the Three Kingdoms.

Home on a care order: who the children are and what the care order is for

Compared to children in other placements, there is much less known about the characteristics and needs of children in the UK who are returned to their birth parents with a care order still in place. That is in spite of evidence to suggest they face more difficulties than young people in other placements. Based on a 2009 census of looked after children in Northern Ireland, just under 10% (n = 193) were found to be living at home under a care order. Case file reviews were conducted for a quarter of these young people (n = 47) to generate descriptive statistics showing a very diverse population. That was followed by semi-structured interviews with members of eight families (ten children and eight birth parent/s), providing transcripts for thematic analysis. Nearly half of the young people whose case files were reviewed had experienced at least one home placement breakdown, but nearly two thirds had a stable last home placement. Care orders appeared to serve two functions: to give legal authority to social services for the monitoring of placements, and to facilitate family access to family support services. Replacing some care orders with supervision orders might better align legal status and actual function.

Intraclonal heterogeneity is a critical early event in the development of myeloma and precedes the development of clinical symptoms.

The mechanisms involved in the progression from monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma (SMM) to malignant multiple myeloma (MM) and plasma cell leukemia (PCL) are poorly understood but believed to involve the sequential acquisition of genetic hits. We performed exome and whole-genome sequencing on a series of MGUS (n=4), high-risk (HR)SMM (n=4), MM (n=26) and PCL (n=2) samples, including four cases who transformed from HR-SMM to MM, to determine the genetic factors that drive progression of disease. The pattern and number of non-synonymous mutations show that the MGUS disease stage is less genetically complex than MM, and HR-SMM is similar to presenting MM. Intraclonal heterogeneity is present at all stages and using cases of HR-SMM, which transformed to MM, we show that intraclonal heterogeneity is a typical feature of the disease. At the HR-SMM stage of disease, the majority of the genetic changes necessary to give rise to MM are already present. These data suggest that clonal progression is the key feature of transformation of HR-SMM to MM and as such the invasive clinically predominant clone typical of MM is already present at the SMM stage and would be amenable to therapeutic intervention at that stage.

Planning for the Unseen and Unheard: the child with ASD

“Children are a kind of indicator species.
If we can build a successful city for children,
we will have a successful city for all people.”

Enrique Peñalosa (former mayor of Bogotá)

Should society be judged by how they treat their weakest members, the concept of the Child Friendly City offers more than ample scope for critiquing the genuine health and inclusivity of our urban environments. If we accept childhood as a crucial human development phase that demands inclusive and welcoming places for play, exploration and growth, many cities today are becoming increasingly barren habitats, arguably full of nothing but empty childhoods. (Raven-Ellison 2015) With children today less able to roam and explore our streets than those of yesteryear, (Bird 2007) the situation is now developing where our young are becoming increasingly socially and spatially excluded from our supposedly shared Built Environment. That progressively restrictive urban realm is particularly pronounced for those with Autism Spectrum Disorder, for whom our cities can be disorientating, difficult and even frightening places.

As a profession we have a responsibility to provide inclusive built environments that do not preclude the presence of the most vulnerable in society, among them those with ASD. Accordingly this paper seeks to introduce emerging research into the current challenges facing these young urban stakeholders before discussing how planning processes and design interventions might make our cities more accessible to those with ASD.

References:

Bird, W. (2007) Natural Thinking, Sandy, Bedfordshire: RSPB.

Raven-Ellison, D. (2015) “London’s Empty Childhoods” in London Essays – Green Spaces, Issue 3 – found at: http://essays.centreforlondon.org/issues/green/londons-empty-childhoods/ accessed 9th May 2016.

Time-limited home-care reablement services for maintaining and improving the functional independence of older adults

Background: Reablement, also known as restorative care, is one possible approach to home-care services for older adults at risk of functional decline. Unlike traditional home-care services, reablement is frequently time-limited (usually six to 12 weeks) and aims to maximise independence by offering an intensive multidisciplinary, person-centred and goal-directed intervention. Objectives:Objectives To assess the effects of time-limited home-care reablement services (up to 12 weeks) for maintaining and improving the functional independence of older adults (aged 65 years or more) when compared to usual home-care or wait-list control group. Search methods:We searched the following databases with no language restrictions during April to June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OvidSP); Embase (OvidSP); PsycINFO (OvidSP); ERIC; Sociological Abstracts; ProQuest Dissertations and Theses; CINAHL (EBSCOhost); SIGLE (OpenGrey); AgeLine and Social Care Online. We also searched the reference lists of relevant studies and reviews as well as contacting authors in the field.Selection criteria:We included randomised controlled trials (RCTs), cluster randomised or quasi-randomised trials of time-limited reablement services for older adults (aged 65 years or more) delivered in their home; and incorporated a usual home-care or wait-list control group. Data collection and analysis:Two authors independently assessed studies for inclusion, extracted data, assessed the risk of bias of individual studies and considered quality of the evidence using GRADE. We contacted study authors for additional information where needed.Main results:Two studies, comparing reablement with usual home-care services with 811 participants, met our eligibility criteria for inclusion; we also identified three potentially eligible studies, but findings were not yet available. One included study was conducted in Western Australia with 750 participants (mean age 82.29 years). The second study was conducted in Norway (61 participants; mean age 79 years). We are very uncertain as to the effects of reablement compared with usual care as the evidence was of very low quality for all of the outcomes reported. The main findings were as follows. Functional status: very low quality evidence suggested that reablement may be slightly more effective than usual care in improving function at nine to 12 months (lower scores reflect greater independence; standardised mean difference (SMD) -0.30; 95% confidence interval (CI) -0.53 to -0.06; 2 studies with 249 participants). Adverse events: reablement may make little or no difference to mortality at 12 months’ follow-up (RR 0.97; 95% CI 0.74 to 1.29; 2 studies with 811 participants) or rates of unplanned hospital admission at 24 months (RR 0.94; 95% CI 0.85 to 1.03; 1 study with 750 participants). The very low quality evidence also means we are uncertain whether reablement may influence quality of life (SMD -0.23; 95% CI -0.48 to 0.02; 2 trials with 249 participants) or living arrangements (RR 0.92, 95% CI 0.62 to 1.34; 1 study with 750 participants) at time points up to 12 months. People receiving reablement may be slightly less likely to have been approved for a higher level of personal care than people receiving usual care over the 24 months’ follow-up (RR 0.87; 95% CI 0.77 to 0.98; 1 trial, 750 participants). Similarly, although there may be a small reduction in total aggregated home and healthcare costs over the 24-month follow-up (reablement: AUD 19,888; usual care: AUD 22,757; 1 trial with 750 participants), we are uncertain about the size and importance of these effects as the results were based on very low quality evidence. Neither study reported user satisfaction with the serviceAuthors’ conclusions:There is considerable uncertainty regarding the effects of reablement as the evidence was of very low quality according to our GRADE ratings. Therefore, the effectiveness of reablement services cannot be supported or refuted until more robust evidence becomes available. There is an urgent need for high quality trials across different health and social care systems due to the increasingly high profile of reablement services in policy and practice in several countries.