Patient-reported outcome measures for asthma:a systematic review

BACKGROUND: Patient-reported outcome measures (PROMs) are measures of the outcome of treatment(s) reported directly by the patient or carer. There is increasing international policy interest in using these to assess the impact of clinical care. AIMS: To identify suitably validated PROMs for asthma and examine their potential for use in clinical settings. METHODS: We systematically searched MEDLINE, EMBASE and Web of Science databases from 1990 onwards to identify PROMs for asthma. These were critically appraised, then narratively synthesised. We also identified the generic PROMs commonly used alongside asthma-specific PROMs. RESULTS: We identifi ed 68 PROMs for asthma, 13 of which were selected through screening as being adequately developed to warrant full-quality appraisal: 8 for adults, 4 for children and 1 for a child's caregiver. The PROMs found to be sufficiently well validated to offer promise for use in clinical settings were the Asthma Quality of Life Questionnaire (AQLQ) and mini-AQLQ for adults, and Pediatric Asthma Quality of Life Questionnaire for children. Rhinasthma was considered promising in simultaneously assessing the impact of asthma and rhinitis in those with coexistent disease. We identified 28 generic PROMs commonly used in conjunction with asthma-specific instruments. CONCLUSIONS: We identified asthma PROMs that offer the greatest potential for use in clinical settings. Further work is needed to assess whether these are fit-for-purpose for use in clinical practice with individual patients. In particular, there is a need to ensure these are validated for use in clinical settings, acceptable to patients, caregivers and clinicians, and yield meaningful outcomes. © 2014 Primary Care Respiratory Society/Macmillan Publishers Limited.

Rethinking the Conflict-Poverty Nexus: From Securitising Intervention to Resilience

We are witnessing nothing less than a revolution in international policy-thinking, with a shift from imagining that international policy-makers can solve development/ security problems through the export or transfer of policy practices or their imposition through conditionality, to understanding that problems should be grasped as emergent consequences of complex social processes which need to be worked with rather than against. This paper, prepared for the 2014 CEPA conference, focuses therefore less on the politicisation and securitisation of questions of conflict and poverty and more on the depoliticisation of questions of conflict and poverty, especially through frameworks of resilience.

Learning from one another: evaluating the impact of horizontal knowledge exchange for environmental management and governance

There is increasing advocacy for inclusive community-based approaches to environmental management, and growing evidence that involving communities improves the sustainability of social-ecological systems. Most community-based approaches rely on partnerships and knowledge exchange between communities, civil society organizations, and professionals such as practitioners and/or scientists. However, few models have actively integrated more horizontal knowledge exchange from community to community. We reflect on the transferability of community owned solutions between indigenous communities by exploring challenges and achievements of community peer-to-peer knowledge exchange as a way of empowering communities to face up to local environmental and social challenges. Using participatory visual methods, indigenous communities of the North Rupununi (Guyana) identified and documented their community owned solutions through films and photostories. Indigenous researchers from this community then shared their solutions with six other communities that faced similar challenges within Guyana, Suriname, Venezuela, Colombia, French Guiana, and Brazil. They were supported by in-country civil society organizations and academics. We analyzed the impact of the knowledge exchange through interviews, field reports, and observations. Our results show that indigenous community members were significantly more receptive to solutions emerging from, and communicated by, other indigenous peoples, and that this approach was a significant motivating force for galvanizing communities to make changes in their community. We identified a range of enabling factors, such as building capacity for a shared conceptual and technical understanding, that strengthens the exchange between communities and contributes to a lasting impact. With national and international policy-makers mobilizing significant financial resources for biodiversity conservation and climate change mitigation, we argue that the promotion of community owned solutions through community peer-to-peer exchange may deliver more long-lasting, socially and ecologically integrated, and investment-effective strategies compared to top-down, expert led, and/or foreign-led initiatives.

La construcción teórica de los acuerdos ejecutivos en el derecho estadounidense. El aporte de la Corte Suprema

La celebración de acuerdos ejecutivos constituye una práctica fuertemente arraigada en la política internacional de los Estados Unidos. En el desarrollo teórico sobre el tema, la jurisprudencia de la Corte Suprema de ese país ha desempeñado un papel significativo al contribuir al esclarecimiento de algunos aspectos complejos de esta clase de convenios. Precisamente, este aporte se propone, como objetivo, examinar algunas instancias relevantes en la evolución de la jurisprudencia del alto tribunal referente a los acuerdos en forma simplificada. El recorrido por el tema permite advertir que la construcción teórica de los acuerdos ejecutivos en el escenario normativo estadounidense constituye un proceso dinámico expuesto a una frecuente renovación de sus criterios centrales.

Psychosocial job quality in a national sample of working Australians: a comparison of persons working with versus without disability

Objectives: There is growing international policy interest in disability employment, yet there has been little investigation of job quality among people working with disability. This study uses Australian national data to compare the psychosocial job quality of people working with versus without disability. Methods: We used 10 annual waves of data from a large representative Australian panel survey to estimate the proportion of the population experiencing poorer psychosocial job quality (overall and by individual 'adversities' of low job control, high demands, high insecurity, and low fairness of pay) by disability status and impairment type. We used logistic regression to examine the pooled cross-sectional associations between disability and job quality, adjusting for age, sex, education and job type. Results: Those working with any disability showed approximately 25% higher odds of reporting one or more adversity at work (OR: 1.23, 95% CI: 1.15, 1.31), and this finding was consistent across impairment types with the exception of intellectual/developmental disability. Estimates were largely unchanged after adjustments. Similar results were found for reporting two or more adversities compared one or more. Conclusions: We observed that working people with a disability in Australia reported systematically poorer psychosocial job quality than those working without disability. These results suggest the need for further research to understand the reasons for these patterns, as well as policy and practice efforts to address this inequity.

Why does Iran need Hizbullah?

The political and military commitment of the Islamic Republic of Iran to Hizbullah in Lebanon has gone through the baptism of fire once again. The Syrian crisis has become a critical theatre of war for the three way alliance between Iran, Hizbullah and Syria, celebrated as the ‘axis of resistance’ in Tehran. The Iranian leadership has used the Syrian crisis to further consolidate its ties with Hizbullah and warn potential enemies of the risks in underestimating Iran’s capacity to take the war to them. Iranian leaders call this a strategy of deterrence, warning Israel and the United States of massive retaliation in case they take any action against Iran. Hizbullah is key to that policy. This paper will explore relations between Iran and Hizbullah in the broader context of Iran’s external relations and geo-strategic calculations. It notes the significance of Iran’s revolutionary ideology and its version of Shia Islam in lubricating this relationship. Hizbullah adheres to the ideological principles advanced in Tehran and shares Iran’s Manichean worldview which divides the world between the oppressors and the oppressed. In this perspective, the United States and Israel are seen as the principal oppressors of the Muslim world. This religious and ideological platform has facilitated a close strategic partnership between Iran and Hizbullah. The Syrian crisis has demonstrated that both parties place significant value in this partnership and are prepared to go to extreme lengths to protect it. This consideration has played a major role in Hizbullah’s military steps to defend the Bashar al-Assad’s regime in Syria.

Heritagescaping and the aesthetics of refuge: challenges to urban sustainability

The year 2012 marked the fortieth anniversary of UNESCO’s Convention Concerning the Protection of the World Cultural and Natural Heritage, or World Heritage
Convention. Regarded by many as a hugely successful project, World Heritage has
provided a framework for safeguarding a wide array of historic built environments.
The choice of “sustainable development and the role of communities” as the theme of
the fortieth anniversary was, however, recognition of the significant problems and
challenges this arena of cultural and spatial governance has created for those living in
and around listed sites. Cities have proved particularly challenging, and resistant to
prescriptive modeling at the level of international policy. Evictions, punitive
legislation, rising living costs, and loss of community are the now familiar by‐products of worldheritage that continue to go undocumented and ignored.
Against this backdrop, this chapter traces recent developments and trends surrounding urban heritage conservation, highlighting recent turns towards community‐driven approaches and discourses of sustainability. It then raises the issue of gentrification, with a particular focus on where such problems take on critical importance: small‐scale urban environments. Focusing on Galle in Sri Lanka, the final part of the chapter explores the emergence of a form of “heritagescaping” oriented by an aesthetics of solitude, tran-quility, and quiet comfort. In offering a contribution towards debates around urban sustainability and the role of heritage therein, it is argued that such processes present significant obstacles to the development of more community‐based, culturally sustainable forms of heritage conservation.

The threat of autocracy diffusion in consolidated democracies? The case of China, Singapore and Australia

The majority of today’s authoritarian regimes have little hope of promoting autocracy beyond their own borders, let alone to consolidated democratic countries. However, China and Singapore are two prominent examples of non-democratic countries whose soft power arsenals have given them some global appeal beyond that enjoyed by most authoritarian regimes. But to what extent has China’s and Singapore’s power of example influenced consolidated democracies in terms that the latter wanting to replicate some political practices or even norms in these non-democratic regimes? In this article, we engage recent works to examine this question in relation to how Australians perceive the political example offered by China and Singapore. Focusing our analysis on several prominent polls conducted recently by the Lowy Institute for International Policy, we suggest that at present there is little evidence of a causal impact of the rise of authoritarian powerhouses such as China and Singapore on how Australians view democracy at home. Through these case studies, this article sheds some light on the theoretical as well as practical questions about the inherent impediments of authoritarian diffusion in consolidated democracies.

LA EDUCACIÓN EN DERECHOS HUMANOS DESDE UNA APROXIMACIÓN LÚDICA: EL MODELO DE NACIONES UNIDAS

Los juegos de rol conocidos como “Modelos de Naciones Unidas” permiten construir una perspectivacognitiva y cultural innovadoras, puesto que nos obligan a posicionarnos frente a los actualesdesafíos internacionales desde un nuevo lugar: el del Otro. El mayor desafío pasa por representarfielmente la política exterior de aquel país que se representa, y así este ejercicio abre ventanas amundos desconocidos que rompen con estructuras mentales e imaginarios colectivos sobre los quese asientan el prejuicio y la discriminación negativa. Debe sumarse el enfoque interdisciplinariosobre el que se construye la práctica: las situaciones por problematizar exigen un esfuerzo conceptual ampliado y holístico para obtener una propuesta superadora.Tomando como caso testigo el 4º MONUUNQ (2009) se intentará sostener la idea de que la actuaciónlogra habilitar saberes, competencias y perspectivas cognitivas nuevas para la persona que,en su insistencia y ejercicio, progresivamente consigue ir construyendo un empoderamiento real.Tarde o temprano, el sujeto activo en dichas prácticas, trasladará el aprendizaje a su vida cotidianay potenciará una verdadera educación en derechos humanos.La “mediación normativa” sucede en el espacio público, lugar desde donde se debe luchar por serreconocido por los pares, con y desde los otros, puesto que para obtener una negociación activa y unliderazgo fructífero que se plasme en el documento escrito final, el estudiante deberá mantenerse en el margen de los códigos de la diplomacia internacional: oratoria, respeto al protocolo, conocimientode los procedimientos, y defensa irrenunciable a los valores constituyentes de la ONU.AbstractRole plays known as ‘United Nations Models’ allow us to build an innovative cognitive and cultural perspective,since they make us be positioned in front of contemporary international challenges from a new place:the other’s place. The biggest challenge is to truly represent the international policy of the country being represented, and that is how this exercise opens windows to unknown worlds which break mental structuresand collective imaginaries, above which prejudice and negative discrimination settle. The interdisciplinaryfocus upon which the practice is built has to be added: the simulated situations demand a wider and holisticconceptual effort to obtain an overcoming proposal.Taking as a model 4th MONUUNQ (2009), it is intended to sustain the idea that role playing habilitatesnew skills, competences and cognitive perspectives for the person who, with insistence and exercise, willprogressively build a real empowerment. Sooner or later, the active subject on those practices will move thelearnt contents to his everyday life and will propel an actual Human Rights Education.‘Normative mediation’ takes place in the public space, the place from which people should fight to be recognizedby equals, ‘with and from other people’, since to obtain an active negotiation and fruitful leadershipwhich will turn into a final written document, the student will have to abide by the codes of internationaldiplomacy – oratory, protocol respect, procedure acknowledge, and defense of the constitutive values of United Nations Organization.

International trends in the implementation of assessment for learning: Implications for policy and practice

This paper discusses the emergence of assessment for learning (AfL) across the globe with particular attention given to Western educational jurisdictions. Authors from Australia, Canada, Ireland, Israel, New Zealand, Norway, and the USA explain the genesis of AfL, its evolution and impact on school systems, and discuss current trends in policy directions for AfL within their respective countries. The authors also discuss the implications of these various shifts and the ongoing tensions that exist between AfL and summative forms of assessment within national policy initiatives.

The Politics of Adoption: International Perspectives on Law, Policy and Practice, Third edition

Adoption is a complex social phenomenon, intimately knitted into its family law framework and shaped by the pressures affecting the family in its local social context. It is a mirror reflecting the changes in our family life and the efforts of family law to address those changes. This has caused it to be variously defined in different societies in the same society, at different times and across a range of contemporary societies.

Medicalising Prohibition : Harm reduction in Finnish and International Drug Policy

The increase in drug use and related harms in the late 1990s in Finland has come to be referred to as the second drug wave. In addition to using criminal justice as a basis of drug policy, new kinds of drug regulation were introduced. Some of the new regulation strategies were referred to as "harm reduction". The most widely known practices of harm reduction include needle and syringe exchange programmes for intravenous drug users and medicinal substitution and maintenance treatment programmes for opiate users. The purpose of the study is to examine the change of drug policy in Finland and particularly the political struggle surrounding harm reduction in the context of this change. The aim is, first, to analyse the content of harm reduction policy and the dynamics of its emergence and, second, to assess to what extent harm reduction undermines or threatens traditional drug policy. The concept of harm reduction is typically associated with a drug policy strategy that employs the public health approach and where the principal focus of regulation is on drug-related health harms and risks. On the other hand, harm reduction policy has also been given other interpretations, relating, in particular, to human rights and social equality. In Finland, harm reduction can also be seen to have its roots in criminal policy. The general conclusion of the study is that rather than posing a threat to a prohibitionist drug policy, harm reduction has come to form part of it. The implementation of harm reduction by setting up health counselling centres for drug users with the main focus on needle exchange and by extending substitution treatment has implied the creation of specialised services based on medical expertise and an increasing involvement of the medical profession in addressing drug problems. At the same time the criminal justice control of drug use has been intensified. Accordingly, harm reduction has not entailed a shift to a more liberal drug policy nor has it undermined the traditional policy with its emphasis on total drug prohibition. Instead, harm reduction in combination with a prohibitionist penal policy constitutes a new dual-track drug policy paradigm. The study draws on the constructionist tradition of research on social problems and movements, where the analysis centres on claims made about social problems, claim-makers, ways of making claims and related social mobilisation. The research material mainly consists of administrative documents and interviews with key stakeholders. The doctoral study consists of five original articles and a summary article. The first article gives an overview of the strained process of change of drug policy and policy trends around the turn of the millennium. The second article focuses on the concept of harm reduction and the international organisations and groupings involved in defining it. The third article describes the process that in 1996 97 led to the creation of the first Finnish national drug policy strategy by reconciling mutually contradictory views of addressing the drug problem, at the same as the way was paved for harm reduction measures. The fourth article seeks to explain the relatively rapid diffusion of needle exchange programmes after 1996. The fifth article assesses substitution treatment as a harm reduction measure from the viewpoint of the associations of opioid users and their family members.

Bridging East and West : The Establishment of the International Institute for Applied Systems Analysis (IIASA) in the United States Foreign Policy of Bridge Building, 1964-1972.

The dissertation examines the foreign policies of the United States through the prism of science and technology. In the focal point of scrutiny is the policy establishing the International Institute for Applied Systems Analysis (IIASA) and the development of the multilateral part of bridge building in American foreign policy during the 1960s and early 1970s. After a long and arduous negotiation process, the institute was finally established by twelve national member organizations from the following countries: Bulgaria, Canada, Czechoslovakia, Federal Republic of Germany (FRG), France, German Democratic Republic (GDR), Great Britain, Italy, Japan, Poland, Soviet Union and United States; a few years later Sweden, Finland and the Netherlands also joined. It is said that the goal of the institute was to bring together researchers from East and West to solve pertinent problems caused by the modernization process experienced in industrialized world. It originates from President Lyndon B. Johnson s bridge building policies that were launched in 1964, and was set in a well-contested and crowded domain of other international organizations of environmental and social planning. Since the distinct need for yet another organization was not evident, the process of negotiations in this multinational environment enlightens the foreign policy ambitions of the United States on the road to the Cold War détente. The study places this project within its political era, and juxtaposes it with other international organizations, especially that of the OECD, ECE and NATO. Conventionally, Lyndon Johnson s bridge building policies have been seen as a means to normalize its international relations bilaterally with different East European countries, and the multilateral dimension of the policy has been ignored. This is why IIASA s establishment process in this multilateral environment brings forth new information on US foreign policy goals, the means to achieve these goals, as well as its relations to other advanced industrialized societies before the time of détente, during the 1960s and early 1970s. Furthermore, the substance of the institute applied systems analysis illuminates the differences between European and American methodological thinking in social planning. Systems analysis is closely associated with (American) science and technology policies of the 1960s, especially in its military administrative applications, thus analysis within the foreign policy environment of the United States proved particularly fruitful. In the 1960s the institutional structures of European continent with faltering, and the growing tendencies of integration were in flux. One example of this was the long, drawn-out process of British membership in the EEC, another is de Gaulle s withdrawal from NATO s military-political cooperation. On the other hand, however, economic cooperation in Europe between East and West, and especially with the Soviet Union was expanding rapidly. This American initiative to form a new institutional actor has to be seen in that structural context, showing that bridge building was needed not only to the East, but also to the West. The narrative amounts to an analysis of how the United States managed both cooperation and conflict in its hegemonic aspirations in the emerging modern world, and how it used its special relationship with the United Kingdom to achieve its goals. The research is based on the archives of the United States, Great Britain, Sweden, Finland, and IIASA. The primary sources have been complemented with both contemporary and present day research literature, periodicals, and interviews.