Determinants of self-medication with NSAIDs in a Portuguese community pharmacy

Background: Non-steroid anti-inflammatory drugs (NSAIDs) are a widely used therapeutic group in the world, and particularly in the Portuguese population. Objective: To compare NSAID’s use by prescription and self-medication acquisition and to determine the pattern of indication of NSAIDs, their usage profile and possible implications for patients’ safety. Methods: A cross-sectional design was used where individuals presenting at a community pharmacy requesting NSAIDs during the study period (one month) were invited to answer a face-to-face interview where socio-demographic characteristics, the indication pattern and previous experience of side effects were assessed. A follow-up interview was performed one week later to assess the incidence of adverse effects. The study was ethically approved. Results: A sample of 130 NSAIDs users was recruited, comprising mostly women (n=87; 66.9%), actively employed (n=77; 59.2%) and presenting a mean age of 49.5 years old (SD=20.49). An equal proportion of individuals acquired NSAIDs by self-medication and with medical prescription (n=65; 50%). Over 4/5 of patients (n=57; 87.7%) acquiring NSAIDs without a prescription were self-medicated by their own initiative, and only 10.8% (n=7) had been advised by the pharmacist. The most commonly acquired active substances were ibuprofen and diclofenac. Self-medicated users more frequently resorted to topical NSAIDs following short term treatments. The major underlying condition motivating NSAIDs sought were musculoskeletal disorders (45.0%), regardless of the regimen. An important proportion of prevalent users of NSAIDs reported previous experience of adverse effects (11.3%). One week after initiating NSAID therapy, a small proportion of patients reported incidence of adverse effects. Conclusion: Self-medication with NSAIDs is sought for numerous medical conditions. Reported adverse effects (prevalent and incident) confirm the need for a more rational use of NSAIDs and ongoing pharmacovigilance.

Ledroit Park, A Portrait In Black And White: A Study Of Historic Districts, Social Change, And The Process Of Neighborhood Placemaking

This research examines the process of placemaking in LeDroit Park, a residential Washington, DC, neighborhood with a historic district at its core. Unpacking the entwined physical and social evolution of the small community within the context of the Nation’s Capital, this analysis provides insight into the role of urban design and development as well as historic designation on shaping collective identity. Initially planned and designed in 1873 as a gated suburb just beyond the formal L’Enfant-designed city boundary, LeDroit Park was intended as a retreat for middle and upper-class European Americans from the growing density and social diversity of the city. With a mixture of large romantic revival mansions and smaller frame cottages set on grassy plots evocative of an idealized rural village, the physical design was intentionally inwardly-focused. This feeling of refuge was underscored with a physical fence that surrounded the development, intended to prevent African Americans from nearby Howard University and the surrounding neighborhood, from using the community’s private streets to access the City of Washington. Within two decades of its founding, LeDroit Park was incorporated into the District of Columbia, the surrounding fence was demolished, and the neighborhood was racially integrated. Due to increasingly stringent segregation laws and customs in the city, this period of integration lasted less than twenty years, and LeDroit Park developed into an elite African American enclave, using the urban design as a bulwark against the indignities of a segregated city. Throughout the 20th century housing infill and construction increased density, yet the neighborhood never lost the feeling of security derived from the neighborhood plan. Highlighting the architecture and street design, neighbors successfully received historic district designation in 1974 in order to halt campus expansion. After a stalemate that lasted two decades, the neighborhood began another period of transformation, both racial and socio-economic, catalyzed by a multi-pronged investment program led by Howard University. Through interviews with long-term and new community members, this investigation asserts that the 140-year development history, including recent physical interventions, is integral to placemaking, shaping the material character as well as the social identity of residents.

Assessing the impacts of community participation policy and practice in Scotland and England

Background: Community participation has become an integral part of many areas of public policy over the last two decades. For a variety of reasons, ranging from concerns about social cohesion and unrest to perceived failings in public services, governments in the UK and elsewhere have turned to communities as both a site of intervention and a potential solution. In contemporary policy, the shift to community is exemplified by the UK Government’s Big Society/Localism agenda and the Scottish Government’s emphasis on Community Empowerment. Through such policies, communities have been increasingly encouraged to help themselves in various ways, to work with public agencies in reshaping services, and to become more engaged in the democratic process. These developments have led some theorists to argue that responsibilities are being shifted from the state onto communities, representing a new form of 'government through community' (Rose, 1996; Imrie and Raco, 2003). Despite this policy development, there is surprisingly little evidence which demonstrates the outcomes of the different forms of community participation. This study attempts to address this gap in two ways. Firstly, it explores the ways in which community participation policy in Scotland and England are playing out in practice. And secondly, it assesses the outcomes of different forms of community participation taking place within these broad policy contexts. Methodology: The study employs an innovative combination of the two main theory-based evaluation methodologies, Theories of Change (ToC) and Realist Evaluation (RE), building on ideas generated by earlier applications of each approach (Blamey and Mackenzie, 2007). ToC methodology is used to analyse the national policy frameworks and the general approach of community organisations in six case studies, three in Scotland and three in England. The local evidence from the community organisations’ theories of change is then used to analyse and critique the assumptions which underlie the Localism and Community Empowerment policies. Alongside this, across the six case studies, a RE approach is utilised to examine the specific mechanisms which operate to deliver outcomes from community participation processes, and to explore the contextual factors which influence their operation. Given the innovative methodological approach, the study also engages in some focused reflection on the practicality and usefulness of combining ToC and RE approaches. Findings: The case studies provide significant evidence of the outcomes that community organisations can deliver through directly providing services or facilities, and through influencing public services. Important contextual factors in both countries include particular strengths within communities and positive relationships with at least part of the local state, although this often exists in parallel with elements of conflict. Notably this evidence suggests that the idea of responsibilisation needs to be examined in a more nuanced fashion, incorporating issues of risk and power, as well the active agency of communities and the local state. Thus communities may sometimes willingly take on responsibility in return for power, although this may also engender significant risk, with the balance between these three elements being significantly mediated by local government. The evidence also highlights the impacts of austerity on community participation, with cuts to local government budgets in particular increasing the degree of risk and responsibility for communities and reducing opportunities for power. Furthermore, the case studies demonstrate the importance of inequalities within and between communities, operating through a socio-economic gradient in community capacity. This has the potential to make community participation policy regressive as more affluent communities are more able to take advantage of additional powers and local authorities have less resource to support the capacity of more disadvantaged communities. For Localism in particular, the findings suggest that some of the ‘new community rights’ may provide opportunities for communities to gain power and generate positive social outcomes. However, the English case studies also highlight the substantial risks involved and the extent to which such opportunities are being undermined by austerity. The case studies suggest that cuts to local government budgets have the potential to undermine some aspects of Localism almost entirely, and that the very limited interest in inequalities means that Localism may be both ‘empowering the powerful’ (Hastings and Matthews, 2014) and further disempowering the powerless. For Community Empowerment, the study demonstrates the ways in which community organisations can gain power and deliver positive social outcomes within the broad policy framework. However, whilst Community Empowerment is ostensibly less regressive, there are still significant challenges to be addressed. In particular, the case studies highlight significant constraints on the notion that communities can ‘choose their own level of empowerment’, and the assumption of partnership working between communities and the local state needs to take into account the evidence of very mixed relationships in practice. Most importantly, whilst austerity has had more limited impacts on local government in Scotland so far, the projected cuts in this area may leave Community Empowerment vulnerable to the dangers of regressive impact highlighted for Localism. Methodologically, the study shows that ToC and RE can be practically applied together and that there may be significant benefits of the combination. ToC offers a productive framework for policy analysis and combining this with data derived from local ToCs provides a powerful lens through which to examine and critique the aims and assumptions of national policy. ToC models also provide a useful framework within which to identify specific causal mechanisms, using RE methodology and, again, the data from local ToC work can enable significant learning about ‘what works for whom in what circumstances’ (Pawson and Tilley, 1997).

Clydebank in the inter-war years: a study in economic and social change

The main theme of this thesis is the social, economic and political response of a single community to economic dislocation in the interwar years. The community under consideration is Clydebank., The thesis is divided into several parts. Part I establishes the development of the burgh and considers the physical framework of the community, mainly in the years before 1919. The town's characteristics are examined in terms of population structure and development between the world wars. In the last part of this section there is a review of the economic structure of the burgh and changes occurring in it between 1919 and 1939. In Part II consideration is given to the actual extent and form of the unemployment affecting Clydebank at this time, and comparison is made with other communities and geographic/economic areas. Attention is then focussed more narrowly on the actual individuals suffering unemployment in the burgh during the 1930s, in an attempt to personalise the experience of the unemployed. Part III reviews central and local government responses to the situation in which Clydebank found itself oetween 1919 and 1939. Central government policies discussed include unemployment insurance, public works, the Special Areas legislation, assistance in the construction of the 534 "Queen Mary" and the direction of financial support to areas of particular need. Amongst local authority actions described are additional local support for the poor, public works, efforts to attract new industry to the town, attempts to deal with the housing problem which was particularly acute at times of high unemployment and measures to maintain health standards in the community. In Part IV the responses of the community to unemployment and government policies are detailed. The burgh's commercial sector is surveyed as are developments in leisure provision, religion, temperance and crime, and local politics. A number of individual responses are also given consideration such as migration, commuting, changes in birth and marriage rates and suicide.

Training civic bridge builders: Outcomes of community leadership development programs

As rural communities experience rapid economic, demographic, and political change, program interventions that focus on the development of community leadership capacity could be valuable. Community leadership development programs have been deployed in rural U.S. communities for the past 30 years by university extension units, chambers of commerce, and other nonprofit foundations. Prior research on program outcomes has largely focused on trainees’ self-reported change in individual leadership knowledge, skills, and attitudes. However, postindustrial leadership theories suggest that leadership in the community relies not on individuals but on social relationships that develop across groups akin to social bridging. The purpose of this study is to extend and strengthen prior evaluative research on community leadership development programs by examining program effects on opportunities to develop bridging social capital using more rigorous methods. Data from a quasi-experimental study of rural community leaders (n = 768) in six states are used to isolate unique program effects on individual changes in both cognitive and behavioral community leadership outcomes. Regression modeling shows that participation in community leadership development programs is associated with increased leadership development in knowledge, skills, attitudes, and behaviors that are a catalyst for social bridging. The community capitals framework is used to show that program participants are significantly more likely to broaden their span of involvement across community capital asset areas over time compared to non-participants. Data on specific program structure elements show that skills training may be important for cognitive outcomes while community development learning and group projects are important for changes in organizational behavior. Suggestions for community leadership program practitioners are presented.

Too many presidents "spoil the broth"?- What role for the European Commission in global climate change politics?

The European Union is the only supranational organisation to have both implemented ‘domestic’ climate change policy and provided leadership for the international community on adaptation and mitigation measures. Although the competence for action in climate change is shared between the national governments and the supranational level of the European Union, on behalf of the EU the European Commission has played a prominent role in international climate change negotiations. The Lisbon Treaty (in force December 2009) brought a number of changes to the institutional framework of the European Union, most significantly to the European Council and the external role of the EU. These changes appear to have added to the complexity which surrounds issues of the external representation of the EU and not simplified them – are there too many ‘Presidents’ of these institutions vying for a role? This paper questions the extent to which these changes will impact on the Commission headed by Jose Manuel Barroso, Barroso II Commission (2009-2014), particularly on Barroso’s ability to provide leadership on ‘domestic’ climate change policy and hence direction to the approach which the EU takes in global climate change politics.

Uncertainties in projecting climate-change impacts in marine ecosystems

Projections of the impacts of climate change on marine ecosystems are a key prerequisite for the planning of adaptation strategies, yet they are inevitably associated with uncertainty. Identifying, quantifying, and communicating this uncertainty is key to both evaluating the risk associated with a projection and building confidence in its robustness. We review how uncertainties in such projections are handled in marine science. We employ an approach developed in climate modelling by breaking uncertainty down into (i) structural (model) uncertainty, (ii) initialization and internal variability uncertainty, (iii) parametric uncertainty, and (iv) scenario uncertainty. For each uncertainty type, we then examine the current state-of-the-art in assessing and quantifying its relative importance. We consider whether the marine scientific community has addressed these types of uncertainty sufficiently and highlight the opportunities and challenges associated with doing a better job. We find that even within a relatively small field such as marine science, there are substantial differences between subdisciplines in the degree of attention given to each type of uncertainty. We find that initialization uncertainty is rarely treated explicitly and reducing this type of uncertainty may deliver gains on the seasonal-to-decadal time-scale. We conclude that all parts of marine science could benefit from a greater exchange of ideas, particularly concerning such a universal problem such as the treatment of uncertainty. Finally, marine science should strive to reach the point where scenario uncertainty is the dominant uncertainty in our projections.

Mindfulness-Based Cognitive Therapy for older people in a community setting: a mixed methods feasibility study

Rationale: In line with complex intervention development, this research takes a systematic approach to examining the feasibility and acceptability of delivering Mindfulness-Based Cognitive Therapy (MBCT) to older people who experience symptoms of depression. Methods: A mixed methods approach was adopted in line with recommendations made by the MRC Complex Intervention Development framework. Quantitative and qualitative methods were combined by administering questionnaires as well as conducting post intervention interviews. A number of trial feasibility factors were examined such as recruitment and attrition rates. Qualitative data was analysed using Braun and Clarke’s thematic analysis framework. Results: Nine participants started the MBCT intervention and six completed the 8-week programme. The results suggest that MBCT for older people is feasible and acceptable. Participants reported improved mindfulness skills. Participants responded positively to being asked to take part in research and appeared to particularly value the group delivery format of the intervention. Conclusions: MBCT is both feasible and acceptable for older people experiencing symptoms of depression. Further research is required with larger sample sizes to allow for more robust statistical exploration of outcome measures, including mechanisms of change.

Abrupt shifts in the Gironde fish community: an indicator of ecological changes in an estuarine ecosystem

For decades, global climate change has directly and indirectly affected the structure and function of ecosystems. Abrupt changes in biodiversity have been observed in response to linear or sudden modifications to the environment. These abrupt shifts can cause long-term reorganizations within ecosystems, with communities exhibiting new functional responses to environmental factors. Over the last 3 decades, the Gironde estuary in southwest France has experienced 2 abrupt shifts in both the physical and chemical environments and the pelagic community. Rather than describing these shifts and their origins, we focused on the 3 inter-shift periods, describing the structure of the fish community and its relationship with the environment during these periods. We described fish biodiversity using a limited set of descriptors, taking into account both species composition and relative species abundances. Inter-shift ecosystem states were defined based on the relationship between this description and the hydro-physico-chemical variables and climatic indices defining the main features of the environment. This relationship was described using generalized linear mixed models on the entire time series and for each inter-shift period. Our results indicate that (1) the fish community structure has been significantly modified, (2) environmental drivers influencing fish diversity have changed during these 3 periods, and (3) the fish-environment relationships have been modified over time. From this, we conclude a regime shift has occurred in the Gironde estuary. We also highlight that anthropogenic influences have increased, which re-emphasizes the importance of local management in maintaining fish diversity and associated goods and services within the context of climate change.

Catalyst: Architecture for Change and Social Justice

In major cities today, there are neighborhoods that have been continually underserved and as a result are in decay. Private investors and developers turn to these particular neighborhoods, propose large developments that gentrify these areas, displacing communities and with them their social, political, and economic issues. The purpose of this thesis is to analyze South West, Baltimore, a community composed of 8 neighborhoods on the verge of being gentrified, by incoming development. Through investigating the key issues present in this community for many years, this thesis will attempt to develop a catalytic environment, which will facilitate change within the community by providing a place for its members to help tackle these issues, improving their circumstances, and the circumstances of the neighborhoods they form part of.

Governance and community capitals : understanding how governance has worked in three faith-based schools in the Western Highlands of Papua New Guinea

This thesis, titled Governance and Community Capitals, explores the kinds of practical processes that have made governance work in three faith-based schools in the Western Highlands of Papua New Guinea (PNG). To date, the nation of PNG has been unable to meet its stated educational goals; however, some faith-based primary schools have overcome educational challenges by changing their local governance systems. What constitutes good governance in developing countries and how it can be achieved in a PNG schooling context has received very little scholarly attention. In this study, the subject of governance is approached at the nexus between the administrative sciences and asset-based community development. In this space, the researcher provides an understanding of the contribution that community capitals have made to understandings of local forms of governance in the development context. However, by and large, conceptions of governance have a history of being positioned within a Euro-centric frame and very little, if anything is known about the naming of capitals by indigenous peoples. In this thesis, six indigenous community capitals are made visible, expanding the repertoire of extant capitals published to date. The capitals identified and named in this thesis are: Story, Wisdom, Action, Blessing, Name and Unity. In-depth insights into these capitals are provided and through the theoretical idea of performativity, the researcher advances an understanding of how the habitual enactment of the practical components of the capitals made governance work in this unique setting. The study draws from a grounded and appreciative methodology and is based on a case study design incorporating a three-stage cycle of investigation. The first stage tested the application of an assets-based method to documentary sources of data including most significant change stories, community mapping and visual diaries. In the second stage, a group process method relevant to a PNG context was developed and employed. The third stage involved building theory from case study evidence using content analysis, language and metaphorical speech acts as guides for complex analysis. The thesis demonstrates the contribution that indigenous community capitals can make to understanding local forms of governance and how PNG faith-based schools meet their local governance challenges.

Integrating Environmental Justice and Social-Ecological Resilience for Successful Adaptation to Climate Change: Lessons from African American Communities on the Eastern Shore of the Chesapeake Bay

This research concerns the conceptual and empirical relationship between environmental justice and social-ecological resilience as it relates to climate change vulnerability and adaptation. Two primary questions guided this work. First, what is the level of resilience and adaptive capacity for social-ecological systems that are characterized by environmental injustice in the face of climate change? And second, what is the role of an environmental justice approach in developing adaptation policies that will promote social-ecological resilience? These questions were investigated in three African American communities that are particularly vulnerable to flooding from sea-level rise on the Eastern Shore of the Chesapeake Bay. Using qualitative and quantitative methods, I found that in all three communities, religious faith and the church, rootedness in the landscape, and race relations were highly salient to community experience. The degree to which these common aspects of the communities have imparted adaptive capacity has changed over time. Importantly, a given social-ecological factor does not have the same effect on vulnerability in all communities; however, in all communities political isolation decreases adaptive capacity and increases vulnerability. This political isolation is at least partly due to procedural injustice, which occurs for a number of interrelated reasons. This research further revealed that while all stakeholders (policymakers, environmentalists, and African American community members) generally agree that justice needs to be increased on the Eastern Shore, stakeholder groups disagree about what a justice approach to adaptation would look like. When brought together at a workshop, however, these stakeholders were able to identify numerous challenges and opportunities for increasing justice. Resilience was assessed by the presence of four resilience factors: living with uncertainty, nurturing diversity, combining different types of knowledge, and creating opportunities for self-organization. Overall, these communities seem to have low resilience; however, there is potential for resilience to increase. Finally, I argue that the use of resilience theory for environmental justice communities is limited by the great breadth and depth of knowledge required to evaluate the state of the social-ecological system, the complexities of simultaneously promoting resilience at both the regional and local scale, and the lack of attention to issues of justice.

Changes in the community structure of urban and rural forest patches in Baltimore from 1998 to 2015

Urban forests are often highly fragmented with many exotic species. Altered disturbance regimes and environmental pollutants influence urban forest vegetation. One of the best ways to understand the impacts of land-use on forest composition is through long-term research. In 1998, the Baltimore Ecosystem Study established eight forest plots to investigate the impacts of urbanization on natural ecosystems. Four plots were located in urban forest patches and four were located in rural forests. In 2015, I revisited these plots to measure abundances and quantify change in forest composition, diversity, and structure. Sapling, shrub, and seedling abundance were reduced in the rural plots. Alpha diversity and turnover was lower in the rural plots. Beta diversity was reduced in the rural plots. The structure of the urban plots was mostly unchanged, except for a highly reduced sapling layer. Beta diversity in the urban plots was consistent across surveys due to high species turnover.

Prevenção primária da toxicodependência, "Do Ministério à Escola"

Neste estudo realiza-se uma reflexão crítica em torno da investigação-ação desenvolvida na Escola Secundária D. Dinis, por ocasião do Estágio. A investigação-ação pretendeu contribuir para a resposta à questão: «Em que medida é que as atividades de complemento curricular podem apoiar a alteração de comportamentos dos alunos face à Toxicodependência?» A amostra do estudo foi constituída por quarenta e um alunos, com idades compreendidas entre os quinze e os vinte e um anos, tendo a maioria dezasseis ou dezassete anos de idade. Os métodos e os instrumentos utilizados caraterizaram-se pela realização da atividade em cabanas de Tavira, a aplicação dos questionários antes e depois da atividade em Tavira e por último, a realização de uma conversa com os alunos envolvidos após a atividade acerca da prevenção primária da toxicodependência. Foram implementadas ações, no seio escolar, que permitiram envolver alunos, professores e funcionários, no sentido de realizar uma Prevenção Primária da Toxicodependência, em Tavira, com um conjunto de alunos da Escola Secundária D. Diniz. O impato [sic] das atividades foram estimadas a partir das diferenças das perceções dos alunos à entrada e saída das ações, face à temática em questão. Foi ainda analisada a formação desenvolvida e ainda uma “conversa” após a atividade, em jeito de balanço. A reflexão crítica foca-se no impato que a investigação-ação teve nos alunos, na comunidade escolar e no nosso desenvolvimento profissional, recorrendo-se à experiência vivida e à teoria para a sua fundamentação.

INTERACTIVE EFFECTS OF CLIMATE CHANGE AND FUNGAL COMMUNITIES ON THE DECOMPOSITION OF WOOD-DERIVED CARBON IN FOREST SOILS

Soils are the largest sinks of carbon in terrestrial ecosystems. Soil organic carbon is important for ecosystem balance as it supplies plants with nutrients, maintains soil structure, and helps control the exchange of CO2 with the atmosphere. The processes in which wood carbon is stabilized and destabilized in forest soils is still not understood completely. This study attempts to measure early wood decomposition by different fungal communities (inoculation with pure colonies of brown or white rot, or the original microbial community) under various interacting treatments: wood quality (wood from +CO2, +CO2+O3, or ambient atmosphere Aspen-FACE treatments from Rhinelander, WI), temperature (ambient or warmed), soil texture (loamy or sandy textured soil), and wood location (plot surface or buried 15cm below surface). Control plots with no wood chips added were also monitored throughout the study. By using isotopically-labelled wood chips from the Aspen-FACE experiment, we are able to track wood-derived carbon losses as soil CO2 efflux and as leached dissolved organic carbon (DOC). We analyzed soil water for chemical characteristics such as, total phenolics, SUVA254, humification, and molecular size. Wood chip samples were also analyzed for their proportion of lignin:carbohydrates using FTIR analysis at three time intervals throughout 12 months of decomposition. After two years of measurements, the average total soil CO2 efflux rates were significantly different depending on wood location, temperature, and wood quality. The wood-derived portion soil CO2 efflux also varied significantly by wood location, temperature, and wood quality. The average total DOC and the wood-derived portion of DOC differed between inoculation treatments, wood location, and temperature. Soil water chemical characteristics varied significantly by inoculation treatments, temperature, and wood quality. After 12 months of decomposition the proportion of lignin:carbohydrates varied significantly by inoculation treatment, with white rot having the only average proportional decrease in lignin:carbohydrates. Both soil CO2 efflux and DOC losses indicate that wood location is important. Carbon losses were greater from surface wood chips compared with buried wood chips, implying the importance of buried wood for total ecosystem carbon stabilization. Treatments associated with climate change also had an effect on the level of decomposition. DOC losses, soil water characteristics, and FTIR data demonstrate the importance of fungal community on the degree of decomposition and the resulting byproducts found throughout the soil.