Description of a multifaceted strategy for recruiting general practitioners and community pharmacists to talk about medication errors

Objective: To describe the use of a multifaceted strategy for recruiting general practitioners (GPs) and community pharmacists to talk about medication errors which have resulted in preventable drug-related admissions to hospital. This is a potentially sensitive subject with medicolegal implications. Setting: Four primary care trusts and one teaching hospital in the UK. Method: Letters were mailed to community pharmacists and general practitioners asking for provisional consent to be interviewed and permission to contact them again should a patient be admitted to hospital as a result of a medication error. In addition, GPs were asked for permission to approach their patients should they be admitted to hospital. A multifaceted approach to recruitment was used including gaining support for the study from professional defence agencies and local champions. Key findings: Eighty-five percent (310/385) of GPs and 62% (93/149) of community pharmacists responded to the letters. Eighty-five percent (266/310) of GPs who responded and 81% (75/93) of community pharmacists who responded gave provisional consent to participate in interviews. All GPs (14 out of 14) and community pharmacists (10 out of 10) who were subsequently asked to participate, when patients were admitted to hospital, agreed to be interviewed. Conclusion: The multifaceted approach to recruitment was associated with an impressive response when asking healthcare professionals to be interviewed about medication errors which have resulted in preventable drug-related morbidity.

A follow-up study of characteristics of young people that dropout and continue psychotherapy: service implications for a clinic in the community

Background: The paper reports the findings from a follow-up study of the factors that contribute to whether young people dropout or continue once-weekly psychotherapy at a voluntary sector psychotherapy service for young people aged 12 to 21 years. Method: The study uses data from an ongoing audit of the psychotherapy service that started in 1993; 882 young people were included in the study. Premature termination of treatment was defined as dropping out before the 21st session. Continuation in treatment was defined as remaining in therapy after 20 sessions. Measures and areas of interest used in the study include diagnostic measures, the Youth Self Report Form and Young Adult Self Report Form, demographic characteristics and treatment related information. Results: Young people who continued in treatment were more likely to be older, have anxieties about sexual and relationship issues and have higher scores on self-reported anxiety-depression. Young people who dropped out of treatment were more likely to be younger, have higher self-reported delinquency scores, have a diagnosis of hyperactivity-conduct disorder and be homeless. Conclusions: The study of treatment termination has demonstrated the value of service audit and has led to a significant change in clinical practice.

Carbon management, local governance and community engagement

This article examines the role of communities in carbon management as it relates to both climate change and energy policy at the local level and as a seedbed for grassroots activity. The article considers some of the implications of recent policy developments, particularly the ways in which the ‘lines of responsibility’ are now being drawn at the local level. Drawing upon in-depth interviews with local authorities in the UK and the USA, the article examines the political distinctions that are evident between the two situations and the ramifications of these for practical community engagement in carbon management at the local level. Community engagement is likely to be central to the delivery of CO2 reductions, but evidence so far points to a series of challenges that will require a greater emphasis on partnership working between community groups and formal decision-making bodies.

REDD+ and community-controlled forests in low-income countries: any hope for a linkage?

Deforestation and forest degradation are estimated to account for between 12% and 20% of annual greenhouse gas emissions and in the 1990s (largely in the developing world) released about 5.8 Gt per year, which was bigger than all forms of transport combined. The idea behind REDD + is that payments for sequestering carbon can tip the economic balance away from loss of forests and in the process yield climate benefits. Recent analysis has suggested that developing country carbon sequestration can effectively compete with other climate investments as part of a cost effective climate policy. This paper focuses on opportunities and complications associated with bringing community-controlled forests into REDD +. About 25% of developing country forests are community controlled and therefore it is difficult to envision a successful REDD + without coming to terms with community controlled forests. It is widely agreed that REDD + offers opportunities to bring value to developing country forests, but there are also concerns driven by worries related to insecure and poorly defined community forest tenure, informed by often long histories of government unwillingness to meaningfully devolve to communities. Further, communities are complicated systems and it is therefore also of concern that REDD + could destabilize existing well-functioning community forestry systems.

Palm oil, land rights and ecosystem services in Gbarpolu County, Liberia

As part of the rebuilding efforts following the long civil war, the Liberian government has renegotiated long-term contracts with international investors to exploit natural resources. Substantial areas of land have been handed out in large-scale concessions across Liberia during the last five years. While this may promote economic growth at the national level, such concessions are likely to have major environmental, social and economic impacts on local communities, who may not have been consulted on the proposed developments. This report examines the potential socio-economic and environmental impacts of a proposed large-scale oil palm concession in Bopolu District, Gbarpolu County in Liberia. The research provided an in-depth mapping of current resource use, livelihoods and ecosystems services, in addition to analysis of community consultation and perceptions of the potential impacts of the proposed development. This case study of a palm oil concession in Liberia highlights wider policy considerations regarding large-scale land acquisitions in the global South: • Formal mechanisms may be needed to ensure the process of Free, Prior, Informed Consent takes place effectively with affected communities and community land rights are safeguarded. • Rigorous Environmental and Social Impact Assessments need to be conducted before operations start. Accurate mapping of customary land rights, community resources and cultural sites, livelihoods, land use, biodiversity and ecosystems services is a critical tool in this process. • Greater clarity and awareness-raising of land tenure laws and policies is needed at all levels. Good governance and capacity-building of key institutions would help to ensure effective implementation of relevant laws and policies. • Efforts are needed to improve basic services and infrastructure in rural communities and invest in food crop cultivation in order to enhance food security and poverty alleviation. Increasing access to inputs, equipment, training and advice is especially important if male and female farmers are no longer able to practice shifting cultivation due to the reduction/ loss of customary land and the need to farm more intensively on smaller areas of land.

Promoting mother–infant book sharing and infant attention and language development in an impoverished South African population: a pilot study

The low rates of child literacy in South Africa are cause for considerable concern. Research from the developed world shows that parental sharing of picture books with infants and young children is beneficial for child language and cognitive development, as well as literacy skills. We conducted a pilot study to examine whether such benefits might extend to an impoverished community in South Africa, by evaluating the impact of training mothers in book sharing with their 14–18 month old infants. Seventeen mothers received book sharing training; and 13 mothers did not, but instead received a comparison training in toy play. We assessed the mothers’ behavior during both book sharing and toy play before and after training, and we also assessed infant attention and language. Mothers receiving book sharing training engaged well with it, and they also benefited from it; thus, compared to the comparison group mothers, they became more sensitive, more facilitating, and more elaborative with their infants during book sharing, and they also became more sensitive to their infants during toy play. In addition, infants whose mothers received the book sharing training showed greater benefits than the comparison group infants in both their attention and language. Training in book sharing for families living in conditions of marked socio-economic adversity in South Africa has the potential to be of considerable benefit to child developmental progress. A large scale controlled trial is required to confirm this.

How to be a fig wasp down under: the diversity and structure of an Australian fig wasp community

Endophytic insects and their parasitoids provide valuable models for community ecology. The wasp communities in inflorescences of fig trees have great potential for comparative studies, but we must first describe individual communities. Here, we add to the few detailed studies of such communities by describing the one associated with Ficus rubiginosa in Australia. First, we describe community composition, using two different sampling procedures. Overall, we identified 14 species of non-pollinating fig wasp (NPFW) that fall into two size classes. Small wasps, including pollinators, gallers and their parasitoids, were more abundant than large wasps (both galler and parasitoid species). We show that in figs where wasps emerge naturally, the presence of large wasps may partly explain the low emergence of small wasps. During fig development, large gallers oviposit first, before and around the time of pollination, while parasitoids lay eggs after pollination. We further show that parasitoids in the subfamily Sycoryctinae, which comprise the majority of all individual NPFWs, segregate temporally by laying eggs at different stages of fig development. We discuss our results in terms of species co-existence and community structure and compare our findings to those from fig wasp communities on other continents.

Depot-specific modulation of adipokine levels in rat adipose tissue by diet-induced obesity: The effect of aerobic training and energy restriction

The present study examined the effects of aerobic training and energy restriction on adipokines levels in mesenteric (MEAT) and retroperitoneal (RPAT) white adipose tissue from obese rats. Male Wistar rats were fed with standard laboratory diet (Control group) or high fat diet (HFD). After 15 weeks, HFD rats were randomly assigned to the following groups: rats submitted to HFD, which were sedentary (sedentary HFD, n = 8) or trained (trained HFD, n = 8); or submitted to energy-restriction (ER), which were sedentary (sedentary ER, n = 8) or trained (trained ER, n = 8). Trained rats ran on a treadmill at 55% VO(2max) for 60 min/day, 5 days/week, for 10 weeks. ER rats were submitted to a reduction of 20% daily caloric ingestion compared to the Control group. ER and aerobic training decreased body weight, MEAT and RPAT absolute weight, and fat mass. IL-6, IL-10 and TNF-alpha levels were decreased and adiponectin did not change in RPAT in response to ER protocol. On the other hand, ER and the aerobic training protocol decreased IL-6, TNF-alpha and adiponectin levels in MEAT. Absolute MEAT weight showed a positive correlation with IL-6 (r = 0.464), INF-alpha (r = 0.508); and adiponectin (r = 0.342). These results suggest a tissue-specific heterogeneous response in adipokines level. The combination of the protocols (aerobic training and energy restriction) did not induce an enhanced effect. Published by Elsevier Ltd.

Maternal health care professionals perspective on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam

Background. High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

Capability outcomes from educational and ICT capability inputs : an analysis of ICT use in informal education in Kenya

In the field of Information and Communication Technologies for Development (ICT4D) ICT use in education is well studied. Education is often seen as a pre-requisite for development and ICTs are believed to aid in education, e.g. to make it more accessible and to increase its quality. In this paper we study the access and use of ICT in a study circle (SC) education program in the south coast of Kenya. The study is qualitative reporting results based on interviews and observations with SC participants, government officers and SC coordinators and teachers. The study builds on the capability approach perspective of development where individuals’ opportunities and ability to live a life that they value are focused. The aim of the study is to investigate the capability outcomes enabled through the capability inputs access and use of ICT in education as well as the factors that enabled and/or restricted the outcomes. Findings show that many opportunities have been enabled such as an increase in the ability to generate an income, learning benefits, community development and basic human development (e.g. literacy and self-confidence). However, conversion factors such as a poorly developed infrastructure and poor IT literacy prevent many of the individuals from taking full advantage of the ICT and the opportunities it enables. 

Knowledge translation in Uganda : a qualitative study of Ugandan midwives' and managers' perceived relevance of the sub-elements of the context cornerstone in the PARIHS framework

BACKGROUND: A large proportion of the annual 3.3 million neonatal deaths could be averted if there was a high uptake of basic evidence-based practices. In order to overcome this 'know-do' gap, there is an urgent need for in-depth understanding of knowledge translation (KT). A major factor to consider in the successful translation of knowledge into practice is the influence of organizational context. A theoretical framework highlighting this process is Promoting Action on Research Implementation in Health Services (PARIHS). However, research linked to this framework has almost exclusively been conducted in high-income countries. Therefore, the objective of this study was to examine the perceived relevance of the subelements of the organizational context cornerstone of the PARIHS framework, and also whether other factors in the organizational context were perceived to influence KT in a specific low-income setting. METHODS: This qualitative study was conducted in a district of Uganda, where focus group discussions and semi-structured interviews were conducted with midwives (n = 18) and managers (n = 5) within the catchment area of the general hospital. The interview guide was developed based on the context sub-elements in the PARIHS framework (receptive context, culture, leadership, and evaluation). Interviews were transcribed verbatim, followed by directed content analysis of the data. RESULTS: The sub-elements of organizational context in the PARIHS framework--i.e., receptive context, culture, leadership, and evaluation--also appear to be relevant in a low-income setting like Uganda, but there are additional factors to consider. Access to resources, commitment and informal payment, and community involvement were all perceived to play important roles for successful KT. CONCLUSIONS: In further development of the context assessment tool, assessing factors for successful implementation of evidence in low-income settings--resources, community involvement, and commitment and informal payment--should be considered for inclusion. For low-income settings, resources are of significant importance, and might be considered as a separate subelement of the PARIHS framework as a whole.

Assessing Merit Aid and Need-Based Aid At Private Institutions

Institutions provide students with full tuition merit awards through formal scholarship programs for outstanding performance in academics, leadership, community service, and athletics. This brief outlines how institutions fund and utilize merit to increase retention rates, particularly for minority and first generation students.

Exercise Training and Caloric Restriction Prevent Reduction in Cardiac Ca2+-Handling Protein Profile in Obese Rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Combined exercise training in asymptomatic elderly with controlled hypertension: Effects on functional capacity and cardiac diastolic function

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Reproducibility and accuracy of the ICDAS-II for occlusal caries detection

Objectives:The aim of this in vitro study was to assess the inter- and intra-examiner reproducibility and the accuracy of the International Caries Detection and Assessment System-II (ICDAS-II) in detecting occlusal caries.Methods:One hundred and sixty-three molars were independently assessed twice by two experienced dentists using the 0- to 6-graded ICDAS-II. The teeth were histologically prepared and classified using two different histological systems [Ekstrand et al. (1997) Caries Research vol. 31, pp. 224-231; Lussi et al. (1999) Caries Research vol. 33, pp. 261-266] and assessed for caries extension. Sensitivity, specificity, accuracy and area under the ROC curve (A(z)) were obtained at D(2) and D(3) thresholds. Unweighted kappa coefficient was used to assess inter- and intra-examiner reproducibility.Results:For the Ekstrand et al. histological classification the sensitivity was 0.99 and 1.00, specificity 1.00 and 0.69 and accuracy 0.99 and 0.76 at D(2) and D(3), respectively. For the Lussi et al. histological classification the sensitivity was 0.91 and 0.75, specificity 0.47 and 0.62 and accuracy 0.86 and 0.68 at D(2) and D(3), respectively. The A(z) varied from 0.54 to 0.73. The inter- and intra-examiner kappa values were 0.51 and 0.58, respectively.Conclusions:ICDAS-II presented good reproducibility and accuracy in detecting occlusal caries, especially caries lesions in the outer half of the enamel.