Service failures and challenges in responding to people bereaved through drugs and alcohol: An interprofessional analysis

This article reports findings from the first two stages of a three-stage qualitative study which considered the role of services, including public, private and charitable organisations, in responding to the needs of adults bereaved following the drug and/or alcohol-related death of someone close. The study, the first of its kind to explore the landscape and role of services in substance use deaths, was conducted over two sites: south west England and Scotland. In stage 1 of the research, adopting both convenience and purposive sampling, data were collected via semi-structured interviews on experiences and support needs of bereaved individuals (n = 106). In stage 2, six focus groups were conducted with a purposive sample of practitioners (n = 40), including those working for the police, coroner’s service, procurator fiscal depute (Scotland), health service, funeral service, press, clergy, Public Health England, Drugs Policy Unit, bereavement counselling/support and alcohol and drug treatment services, to investigate how services may better respond to this bereavement. Thematic analysis from both data-sets identified two overarching themes. The first, focusing on practitioner responses, captures how these bereaved people may meet with inadequate, unkind, and discriminatory responses from services. Having to navigate unfamiliar, fragmented, and time-consuming procedures compounds the bereaved’s distress at an already difficult time, illustrated by a ‘mapping’ of relevant services. The second relates to challenges and opportunities for those responding. Service failures reflect practitioners’ poor understanding of both substance use bereavement and the range of other practitioners and services involved. Those bereaved are a poorly understood, neglected and stigmatised group of service users. There is a need for services to respond without judgement or insensitive language, and provide information about, communicate and work closely with, other services despite differences in working practices and cultures. These recommendations could positively affect bereaved peoples’ experiences, alleviating stress and overwhelm at a particularly vulnerable time

Mapping the Donor Landscape in Global Health: Tuberculosis

Which donors are working in which countries and on what issues? How can country recipients of aid best identify those donors? Are donor governments themselves adequately aware of one another's presence and efforts on identical issues? These questions reflect key challenges facing donors of international assistance, country recipients of assistance, civil society, and other stakeholders working in the development field, and highlight issues that can make it difficult to effectively negotiate, coordinate, and deliver programs. In the health sector such issues are particularly relevant given the proliferation in the number of donors providing health aid to low- and middle-income countries, and the amount of that aid during the last decade. Such issues carry a new significance in the current era of economic austerity, one that has led donors and recipients to seek more streamlined approaches to health assistance that achieve "value for money." To provide some perspective on the geographic presence of global health donors and to help stakeholders begin to answer some of the above questions, the Kaiser Family Foundation is undertaking a series of analyses to describe the global health "donor landscape." Using three years of data from the Organisation for Economic Co-operation and Development (OECD), we map the geographic landscape of global health donor assistance, looking both at donor presence and magnitude of donor assistance by issue area, region, and country. The effort is intended to shed new light on donor presence within and across recipient countries, and to produce a set of figures and tools that stakeholders can use in both donor and recipient countries. From at least the early 2000s, there have been organized efforts to push for greater transparency and better coordination between donors, and between donors and recipients. These calls contributed to a series of international declarations on aid effectiveness such as the 2002 Monterrey Consensus on Financing for Development and the 2005 Paris Declaration on Aid Effectiveness, in which donors and recipient nations agreed to adhere to a code of good practice and a set of principles that would guide and improve donor assistance. In part, the principles were designed to help alleviate some of the administrative burdens on countries from having multiple donors, and to increase the impact derived from donor funding. They have also, more recently, focused on the importance of donor transparency for increasing "country ownership" by recipients of aid; that is, a country-led response to designing and implementing development programs. In global health, uncoordinated donor activities can reduce efficiency and result in missed opportunities to leverage partnerships, streamline processes, and share experiences. While there have been several health-focused efforts aiming to improve donor coordination and donor transparency these challenges continue today and have gained new significance given the current economic environment.Indeed, with signs that donor assistance is flattening, there has been an even higher premium placed on improving coordination and leveraging existing funding and programs. This report focuses on international assistance for tuberculosis

Mapping The Donor Landscape in Global Health: HIV/AIDS

This report maps the complex network of international assistance aimed at addressing the global impact of HIV/AIDS. The analysis identifies 37 different donors, comprising 26 nations providing bi-lateral support and 11 multilateral programs, providing assistance to 143 recipient countries over a three-year period through 2011. Key findings include:The U.S. provides almost two-thirds of all HIV/AIDS international assistance. The next largest donor, the Global Fund, provides one fifth of all assistance. Together they account for an average of 80 percent global HIV/AIDS assistance.On average, 10 donors were present in each recipient country. Fourteen recipient countries had more than 20 donors present during the three-year period: Ethiopia, Kenya, Tanzania, Malawi, Zimbabwe, Mozambique, Rwanda, South Africa, Uganda, Vietnam, Zambia, India, Burkina Faso and Mali.The biggest donor varies by region, with the United States providing the largest share of assistance in sub-Saharan Africa and North & Central America; the Global Fund providing the largest share in Europe, the Middle East, North Africa, South and Central Asia, South America and Far East Asia; and Australia providing the largest share in Oceania

Mapping the Donor Landscape in Global Health: Malaria

Which donors are working in which countries and on what issues? How can country recipients of aid best identify those donors? Are donor governments themselves adequately aware of one another's presence and efforts on identical issues? These questions reflect key challenges facing donors of international assistance, country recipients of assistance, civil society, and other stakeholders working in the development field, and highlight issues can make it difficult to effectively negotiate, coordinate, and deliver programs. In the health sector such issues are particularly relevant given the proliferation in the number of donors providing health aid to low and middle income countries, and the amount of that aid during the last decade. Such issues carry a new significance in the current era of economic austerity, one that has led donors and recipients to seek more streamlined approaches to health assistance that achieve "value for money." To provide some perspective on the geographic presence of global health donors and to help stakeholders begin to answer some of the above questions, the Kaiser Family Foundation is undertaking a series of analyses to describe the global health "donor landscape." Using three years of data from the Organisation for Economic Co-operation and Development (OECD), we map the geographic landscape of global health donor assistance, looking both at donor presence and magnitude of donor assistance by issue area, region and country. The effort is intended to shed new light on donor presence within and across recipient countries, and to produce a set of figures and tools that stakeholders can use in both donor and recipient countries. From at least the early 2000s, there have been organized efforts to push for greater transparency and better coordination between donors, and between donors and recipients. These calls contributed to a series of international declarations on aid effectiveness such as the 2002 Monterrey Consensus on Financing for Development and the 2005 Paris Declaration on Aid Effectiveness, in which donors and recipient nations agreed to adhere to a code of good practice and a set of principles that would guide and improve donor assistance. In part, the principles were designed to help alleviate some of the administrative burdens on countries from having multiple donors, and to increase the impact derived from donor fundingThey have also, more recently, focused on the importance of donor transparency for increasing "country ownership" by recipients of aid; that is, a country-led response to designing and implementing development programs. In global health, uncoordinated donor activities can reduce efficiency and result in missed opportunities to leverage partnerships, streamline processes, and share experiences. While there have been several health-focused efforts aiming to improve donor coordination and donor transparency these challenges continue today and have gained new significance given the current economic environment. Indeed, with signs that donor assistance is flattening, there has been an even higher premium placed on improving coordination and leveraging existing funding and programs. This report focuses on international assistance for malaria

Compassion or stigma? How adults bereaved by alcohol or drugs experience services

How to promote compassionate care within public services is a concern in several countries; specifically, some British healthcare scandals highlight poor care for service users who may readily be stigmatised as ‘other’. The article therefore aims to understand better the relationship between stigma and compassion. As people bereaved by a drug- or alcohol-related death often experience stigma, the article draws on findings from a major British study, conducted during 2012–2015 by the authors, of people bereaved in this way, in order to see how service provision can be improved. One hundred and six bereaved family members were interviewed in depth about their experiences of loss and support. Thematic analysis developed theoretical understandings of participants’ lived experiences. This article analyses our data on how bereaved people experienced stigma and kindness from practitioners of all kinds. We found that stigma can be mitigated by small acts of kindness from those encountered after the death. Stigma entails stereotyping, othering and disgust, each of which has emotional and cognitive aspects; kindness entails identification and fellow feeling; professionalism has classically entailed emotional detachment, but interviewees found cold professionalism as disturbing as explicit disgust. Drawing on theories concerning the end of life, bereavement and emotional labour, the article analyses the relationship between stigma, kindness and professionalism, and identifies some strategies to counter stigmatisation and foster compassion

“But I’ve always lived here”: Evidence Informed Analysis on Aging in Place

Purpose: The purpose of this poster/presentation is to provide an exploration and analysis of aging in place. To ensure the success of the older adult to remain in their home it is essential to determine and meet the changing needs of the aging population in a way that preserves lifelong health and wellness. Description: The global trend of population aging is on the continual rise due to longer life expectancy and lower fertility rates.1 It is predicted that by the year 2036 one in every four individuals will be a senior citizen. In some areas, the availability of long-term care facilities is not sufficient to meet the needs of the population, resulting in seniors living in hospitals up to 6 months awaiting a room. This problem is expected to continue to grow.1 While age related declines compromise an individual’s ability to maintain their personal wellbeing and household, maintaining independence is essential in the perception of successful aging.2 Aging in place is the primary goal in the aging population; US housing data suggests that this is accomplished by 80% of older adults.2 In addition to benefiting the emotional needs of seniors, aging in place has significant financial benefits on both the individual and the community at large, however the demands of the environment and the abilities of the person must align or a mal-adaptive situation occurs.2 Methods: Search USA: 2010-2019; Ag(e)ing in place, Ag(e)ing in place AND Challenges, Ag(e)ing in place AND quality of life, Ag(e)ing in place AND modification(s), Review of 7 articles Conclusion: Recent evidence is suggesting that in the next 10 years, middle income seniors will no longer be able to afford assisted living facilities so the need for maximizing aging in place will significantly increase. Summary of Use: This poster/presentation provides a summary of the benefits to aging in place, modifications and maintenance requirements for success and analyzes the factors contributing to decision making to ensure successful aging in place. Clinical Relevance: Therapists working in the home health setting are often required to provide appropriate information when asked by their clients if they should or could safely remain in the home, aging in place. This poster/presentation provides therapists with an analysis of the benefits and challenges for individuals desiring to age in place and provides the therapist suitable topics to introduce to the conversation to ensure that an appropriate and evidence-informed decision is made by the client and their family

A New Generation of Collecting Priorities: Case Studies from the Northwest

The last twenty-five years have brought lively, important, and difficult discussions around heritage collections. We are called to broaden our collecting activities to be more inclusive of (among many things) all races, classes, and experiences. We have begun to move away from the troubled legacy of taking collections away from creators and toward empowering those same creators to steward their heritage. We confront a vast universe of current holdings and possible collections and have few models for assessing the opportunities. We also operate with some firm limitations on our budgets, personnel, and space that we have outdistanced with our collecting. The framework of responsible stewardship suggests that we must stop over-collecting. Broader cultural forces call us to make our collections more diverse and representative. Inevitably, both of these mean that we must stop or de-emphasize some collecting in order to make other types possible. Given that our collecting policies outline both our aspirations and limitations, what have we done or failed to do in terms of tending to the collecting policies that we inherited? How have we changed them–or kept them the same? And, moving forward, how do we go about implementing and making public big shifts in our collecting policies? We consider these questions through four case studies from the University of Oregon, Washington State University, Montana State University, and the Anchorage Museum that consider (respectively) two decades of work with LGBTQ+ and indigenous collections, current and clear changes in who is documented, and considerations of capacity as part of stewardship. First presented at the annual meeting of [organization] in May 2023, the case studies spurred lively conversations and are broadly applicable to archives across the west and beyond

Bereavement following a fatal overdose:the experiences of adults in England and Scotland

Aims: Overdoses contribute disproportionately to drug-related deaths (DRDs) in the UK, yet little is known about the experiences and needs of those who are bereaved by such deaths, and how their experiences and needs might differ from other bereavements associated with substance use. Methods: An interview study with 32 adults in England and Scotland (part of a larger study). Findings: Five themes describe the core experiences of this group of bereaved people: drug use, the death, official processes, stigma, and overdose awareness and prevention. Together, these findings offer new insights in to the key features of this type of bereavement; for example, living with substance use including previous overdoses, difficult circumstances surrounding the death, having to negotiate the complex procedures involved in processing the death, the stigma such deaths attract, and feelings of guilt, self-blame and an unworthiness to grieve. Conclusions: There are ways in which bereavement following an overdose differs from bereavement following other deaths associated with alcohol or drugs. Understanding the experiences and needs of this marginalised group can help improve support for them. Furthermore, this group’s experience of witnessing and/or responding to previous overdoses indicates the value in prevention programmes targeting relatives/friends

Inequality and polarisation in health systems’ responsiveness: a cross-country analysis

The World Health Report 2000 proposed three fundamental goals for health systems encompassing population health, health care finance and health systems responsiveness. The goals incorporate both an efficiency and equity dimension. While inequalities in population health and health care finance have motivated two important strands of research, inequalities in responsiveness have received less attention in health economics. This paper examines inequality and polarisation in responsiveness, bridging this gap in the literature and contributing towards an integrated analysis of health systems performance. It uses data from the World Health Survey to measure and compare inequalities in responsiveness across 25 European countries. In order to respect the inherently ordinal nature of the responsiveness data, median-based measures of inequality and polarisation are employed. The results suggest that, in the face of wide differences in the health systems analysed, there exists large variability in inequality in responsiveness across countries

In vivo regulatory phosphorylation of the phosphoenolpyruvate carboxylase AtPPC1 in phosphate-starved Arabidopsis thaliana

PEPC [PEP(phosphoenolpyruvate) carboxylase] is a tightly controlled cytosolic enzyme situated at a major branchpoint in plant metabolism. Accumulating evidence indicates important functions for PEPC and PPCK (PEPC kinase) in plant acclimation to nutritional Pi deprivation. However, little is known about the genetic origin or phosphorylation status of native PEPCs from −Pi (Pi-deficient) plants. The transfer of Arabidopsis suspension cells or seedlings to −Pi growth media resulted in: (i) the marked transcriptional upregulation of genes encoding the PEPC isoenzyme AtPPC1 (Arabidopsis thaliana PEPC1), and PPCK isoenzymes AtPPCK1 and AtPPCK2; (ii) >2-fold increases in PEPC specific activity and in the amount of an immunoreactive 107-kDa PEPC polypeptide (p107); and (iii) In vivo p107 phosphorylation as revealed by immunoblotting of clarified extracts with phosphosite-specific antibodies to Ser-11 (which could be reversed following Pi resupply). Approx. 1.3 mg of PEPC was purified 660-fold from −Pi suspension cells to apparent homogeneity with a specific activity of 22.3 units · mg−1 of protein. Gel filtration, SDS/PAGE and immunoblotting demonstrated that purified PEPC exists as a 440-kDa homotetramer composed of identical p107 subunits. Sequencing of p107 tryptic and Asp-N peptides by tandem MS established that this PEPC is encoded by AtPPC1. Pi-affinity PAGE coupled with immunoblotting indicated stoichiometric phosphorylation of the p107 subunits of AtPPC1 at its conserved Ser-11 phosphorylation site. Phosphorylation activated AtPPC1 at pH 7.3 by lowering its Km(PEP) and its sensitivity to inhibition by L-malate and L-aspartate, while enhancing activation by glucose 6-phosphate. Our results indicate that the simultaneous induction and In vivo phosphorylation activation of AtPPC1 contribute to the metabolic adaptations of −Pi Arabidopsis