Constructing a global understanding of the social ecology of leaving out of home care

Engagement with globalisation is growing in the field of youth transitions from out of home care. This includes cross national exchange of research, policy and practise, regional advocacy networking and global policy development. Furthering this emerging international child welfare perspective requires extending it to countries in the developing world and building conceptual frameworks which encompass a social ecology of care leaving, including its global dimension, the latter needs to address not only the needs, expectations and rights of care leavers but also the theories of change underpinning service design and delivery. Such a model is presented combining resilience and social capital as personal assets situated within a social ecology of support. To illustrate how this provides a means to help engage with the experience of countries where there appears to be very little information available on care leaving, a small scale South African initiative is considered. SA-YES is a youth mentoring project for young people leaving a variety of out of home placements. Planned as a three-year pilot, initial results are encouraging but require more rigorous evaluation focusing on program process and outcomes, quality of interpersonal relationships and synchronisation with cultural expectations and policy environment.

Home medication management practices and associated factors among patients with selected chronic diseases in a community pharmacy in Uganda

ABSTRACT: BACKGROUND: Chronic diseases are rapidly increasing and are currently the major cause of death and disability worldwide. Patients with chronic diseases experience many challenges including medicine-related problems. However, there is limited information about the home management of medicines among these patients. This study therefore was to determine home medication management practices and associated factors among patients with chronic diseases seeking care in a community pharmacy in Uganda. METHODS: A cross-sectional study was conducted in a community pharmacy in Kampala from June to July 2010. A total of 207 consenting chronic disease patients or caregivers of children with chronic disease were consecutively sampled. The patients were visited at home to evaluate their drug management practices and to check their medical forms for disease types and drugs prescribed. An interviewer-administered questionnaire and an observation checklist were used to collect the data. RESULTS: Overall home medication management was inappropriate for 70% (n = 145) of the participants (95% CI = 63.3-76.2) and was associated with perceived severity of disease (not severe OR =0.40, moderately severe OR = 0.35), duration of disease >5 years (OR = 2.15), and health worker not assessing for response to treatment (OR = 2.53). About 52% (n = 107) had inappropriate storage which was associated with inadequate information about the disease (OR = 2.39) and distance to the health facility >5 kilometres (OR = 2.82). Fifteen percent (n = 31) had no drug administration schedule and this was associated with increasing age (OR = 0.97), inadequate information about the disease (OR = 2.96), and missing last appointment for medical review (OR = 6.55). About 9% (n = 18) had actual medication duplication; 1.4% (n = 3) had expired medicines; while 18.4% (n = 38) had drug hoarding associated with increasing number of prescribers (OR = 1.34) and duration of disease (OR = 2.06). About 51% (n = 105) had multiple prescribers associated with perceiving the disease to be non severe (OR = 0.27), and having more than one chronic disease (OR = 2.37). CONCLUSIONS: Patients with chronic disease have poor home management of medicines. In order to limit the occurrence of poor outcomes of treatment or drug toxicity, health providers need to strengthen the education of patients with chronic disease on how to handle their medicines at home.

Moral distress experienced by health care professionals who provide home-based palliative care

Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice.

Energy efficiency investments in the home: Swiss homeowners and expectations about future energy prices

Using conjoint choice experiments, we surveyed 473 Swiss homeowners about their preferences for energy efficiency home renovations.We find that homeowners are responsive to the upfront costs of the renovation projects, governmentoffered rebates, savings in energy expenses, time horizon over which such savings would be realized, and thermal comfort improvement. The implicit discount rate is low, ranging from 1.5 to 3%, depending on model specification. This is consistent with Hassett and Metcalf (1993) and Metcalf and Rosenthal (1995), and with the fact that our scenarios contain no uncertainty. Respondents who feel completely uncertain about future energy prices are more likely to select the status quo (no renovations) in any given choice task and weight the costs of the investments more heavily than the financial gains (subsidies and savings on the energy bills). Renovations are more likely when respondents believe that climate change considerations are important determinants of home renovations. Copyright © 2013 by the IAEE. All rights reserved.

FROM ASCRIPTION TO ACHIEVEMENT - ORIGINS, EDUCATION AND ENTRY TO THE LABOR-FORCE IN THE REPUBLIC OF IRELAND DURING THE 20TH-CENTURY

This paper examines the relationship between class of origin, educational attainment, and class of entry to the labour force, in three cohorts of men in the Republic of Ireland using data collected in 1987. The three cohorts comprise men born (i) before 1937; (ii) between 1937 and 1949; and (iii) between 1950 and 1962. The paper assesses the degree of change over the three cohorts in respect of (a) the gross relationship between origins and entry class; (b) the partial effect (controlling for education) of origin class on entry class; (c) the partial effect of education (controlling for origins) on class of entry. In broad terms the liberal theory of industrialism would imply a movement, over the three cohorts, towards (a) increasing social fluidity; (b) a weakening of the partial effect of origin class; (c) a strengthening of the partial effect of education. These latter two trends should be particularly noticeable in the youngest cohort, which would, to some degree, have benefited from the introduction of free post-primary education in Ireland in 1967.

Our results provide almost no support for these hypotheses. We find that patterns of social fluidity in the origin/entry relationship remain unchanged over the cohorts. The partial effect of class remains relatively constant; and, while the partial effect of education on entry class changes over the cohorts, the most striking result in this area is the declining returns to higher levels of education. While the average level of educational attainment increased over the three cohorts, the advantages accruing to the possession of higher levels of education simultaneously diminished. Taken together our results suggest that, in Ireland, those classes that have historically enjoyed advantages in access to more desirable entry positions in the labour market have been remarkably adept at retaining their advantages during the course of industrialization and through the various educational and other labour market changes that have accompanied this process.

‘Reconsidering Dermot Bolger’s Grotesquery: Class and Sexuality in The Journey Home’

Dermot Bolger's The Journey Home (1990) narrates an often hyperbolic and overblown diatribe against a litany of social and political ills, which elicited frequently critical responses to the novel from reviewers. Yet Bolger's seminal work remains both popular and controversial because of its capacity to shock and upbraid the false morality of Irish society--a society that the author considered to be riven by class inequalities and official abuses. Bolger employs sexual abuse as a metonym for political corruption in the novel, and this essay explores The Journey Home's surreal story of youth in a working-class Dublin suburb in light of more recent revelations of Ireland's legacy of institutional sexual abuse.

Optimising sorting and washing of home-grown maize to reduce fumonisin contamination under laboratory-controlled conditions

Subsistence farming communities with low socio-economic status reliant on a mono cereal maize diet are exposed to fumonisin levels that exceed the provisional maximum tolerable daily intake of 2 mu g kg(-1) body weight day(-1) recommended by the Joint FAO/WHO Expert Committee on Food Additives. In the rural Centane magisterial district, Eastern Cape Province, South Africa, it is customary during food preparation to sort visibly infected maize kernels from good maize kernels and to wash the good kernels prior to cooking. However, this customary practice seems not to sufficiently reduce the fumonisin levels. This is the first study to optimise the reduction of fumonisin mycotoxins in home-grown maize based on customary methods of a rural population, under laboratory-controlled conditions. Maize obtained from subsistence farmers was analysed for the major naturally occurring fumonisins (FB1, FB2 and FB3) by fluorescence HPLC. Large variations were observed in the unsorted and the experimental maize batches attributable to the non-homogeneous distribution of fumonisin contamination in maize kernels. Optimised hand-sorting of maize kernels by removing the visibly infected/damaged kernels (fumonisins, 53.7 +/- 15.0 mg kg(-1), 2.5% by weight) reduced the mean fumonisins from 2.32 +/- 1.16 mg kg(-1) to 0.68 +/- 0.42 mg kg(-1). Hand washing of the sorted good maize kernels for a period of 10 min at 25 degrees C resulted in optimal reduction with no additional improvement for wash periods up to 15 h. The laboratory optimised sorting reduced the fumonisins by 71 +/- 18% and an additional 13 +/- 12% with the 10 min wash. Based on these results and on local practices and practicalities the protocol that would be recommended to subsistence farmers consists of the removal of the infected/damaged kernels from the maize followed by a 10 min ambient temperature water wash. (C) 2010 Elsevier Ltd. All rights reserved.