Barriers to adherence to standard precautions among community health workers: A scoping review

Aim: This review aims to map available evidence on the adherence level and barriers to standard precautions among home-based community health workers. Methods: A scoping review using the JBI protocol searched multiple databases (Medline, CINAHL, PsycINFO and Web of Science) as well as Google Scholar for published articles on standard precaution practices of community health workers during home visits. Search terms included “standard precautions”, “guideline adherence”, “community health” and “home care”. Two-stage screening (title/abstract and full-text) was conducted to select relevant articles. Results: Eight eligible studies yielded three major themes: home environment context, individual factors and organisational factors. Findings indicated low adherence to standard precautions in home care, attributed to factors such as home layout, family or pet interference, cleanliness, limited access to protective equipment (e.g. gloves) and personal protective equipment allergies. Conclusion: Providing healthcare at home is challenging, impacting care quality. Further studies on standard precautions in home care can improve adherence, quality of care and patient outcomes

Health workers’ views of a program to facilitate physical health care in mental health settings: implications for implementation and training

Author version made available in accordance with the publisher's policyObjective Physical co morbidities shorten the lifespans of people with severe mental illness. Mental health clinicians need to support service users in risk factor-related behaviour change. We investigated mental health care workers’ views of a physical health self-management support program to identify implementation requirements. Method Qualitative interviews were conducted with workers who had differing levels of experience with a self-management support program. Themes were identified using interpretive descriptive analysis and then matched against domains used in implementation models to draw implications for successful practice change. Results Three main themes related to (i) understandings of disease management within job roles (ii) requirements for putting self-management support into practice and (iii) challenges of coordination in disease management. Priority domains from implementation models were inner and outer health service settings. Conclusion While staff training is required, practice change for care which takes account of both mental and physical health also requires changes in organisational frameworks

Diverse chemotypes disrupt ion homeostasis in the malaria parasite

The antimalarial spiroindolones disrupt Plasmodium falciparumNa+ regulation and induce an alkalinization of the parasite cytosol. It has been proposed that they do so by inhibiting PfATP4, a parasite plasma membrane P-type ATPase postulated to export Na

A systematic review of dementia research priorities

Introduction: Patient involvement is a critical component of dementia research priority-setting exercises to ensure that research benefits are relevant and acceptable to those who need the most. This systematic review synthesises research priorities and preferences identified by people living with dementia and their caregivers. Methods: Guided by Joanna Briggs Institute methodology, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, we conducted a systematic search in five electronic databases: CINAHL, Medline, PsycINFO, Web of Science and Scopus. The reference lists of the included studies were also manually searched. We combined quantitative and qualitative data for synthesis and descriptive thematic analysis. Results: Eleven studies were included in this review. Findings are grouped into four main categories: Increase in knowledge, education, and awareness; Determining the cause; Sustainability of care; and Cure of dementia and related conditions. Conclusion: There is a need to respond to the stigma associated with dementia, which limits access to care and the quality of life for both people living with dementia and their caregivers. We need to work on changing public, private and workplace attitudes about dementia and encourage supporting and participating in dementia research. Future research should involve people living with dementia and their primary caregivers from culturally and linguistically diverse communities in priority-setting exercises

The lived experience of midwives’ transitioning from a clinical role into teaching in higher education in one jurisdiction of Australia: A pilot study

Aim: The aim of this pilot study was to explore clinician\u27s experience of transitioning from midwifery clinical practice into university in an academic teaching role within one jurisdiction in Australia. Background: There is a dire shortage of midwifery academics globally. In Australia the shortage is symbiotic with the persistent deficit in the midwifery clinical workforce, which is the predominant recruitment pool for universities. The midwifery workforce cannot be replenished without sufficient academics to provide education. Design: Phenomenology was selected as the most appropriate research approach for the study seeking to illuminate the lived experiences of clinicians as they transition into their new role as academics. Methods: Seven participants were recruited purposively from one jurisdiction in Australia between November 2022 and March 2023. Qualitative conversational interviews were performed facilitating each participant to share their narrative. Participants were then able to direct the conversation to share their lived experience of the transition from a midwifery clinician in practice to a midwifery academic in a university. Demographic details were collected for context. Results: Thematic analysis was used following Giorgi\u27s four stage phenomenological process. Four themes were identified from commonalities between the participants, ‘Being a drifter”, ‘Keeping a foot in both camps to maintain clinical credibility’, ‘In at the deep end: Not prepared for the reality of academia’ and ‘Best of both worlds’. Conclusions: The lived experiences of the participants in this study, as they transitioned from clinical midwifery practice to academia can be related to the Theory of Transition where participants navigate: Preparation, Encounter, Adjustment and Stabilisation. A new role in higher education requires adjustment to the reality of working in academia. Midwives who had experiences of being a casual staff member felt they had the best of both worlds, as they gained an insight into the role of an academic whilst remaining in clinical practice. However, many reported that mentorship would have been beneficial to facilitate stabilisation

The Complexities and Discourse of Supervision for Equity and Justice in Teaching and Teacher Education

Supervision is essential to the preparation, support, and retention of teachers and other educational professionals. There are many models and responsibilities of supervisors at all levels. We discuss responsibilities of supervision during teacher preparation, within school contexts, and equity and freedom minded supervision. Additionally, we introduce this special issue. The special issue explores both the complexity and discourse found within situations and contexts pertaining to equity and social justice. Exploring cases of supervision allows for reflection, discussion, and problem solving. Each of these cases call for support and preparation for supervisors as they work within contexts and situations where equitable and just supervision is essential

Understanding forced marriage in Scotland

Executive summary In September 2015, the Scottish Government commissioned a 10 month study to better understand forced marriage in Scotland. This is the first forced marriage study that focuses exclusively on Scotland. The study had three research questions: What is the level and profile of service use relating to forced marriage in Scotland? How are services responding to forced marriage in Scotland? What is the impact of the interventions for forced marriage in Scotland? Methods The study focussed on six areas: Aberdeen, Dundee, East Renfrewshire, Edinburgh, Glasgow and Highland. An analysis of forced marriage policy in each of the six case study areas was undertaken, together with interviews with Protection Leads. One-to-one semi-structured interviews were carried out with a range of professionals including police officers, social workers, legal professionals and staff from Women's Aid organisations and other third sector organisations. Eight in-depth interviews were also conducted with survivors[1] of forced marriage. Additionally, a survey was distributed to 293 organisations - schools and women's organisations in the six study areas, and Women's Aid, minority ethnic and other support organisations throughout Scotland. Key findings and recommendations Level and profile of service use Between 2011 and 2014, there were 191 cases[2] of forced marriage reported by survey respondents, with a fairly even spread across the years. Cases tended to involve young, female South Asian victims being threatened or coerced into marriage largely by their parents and extended families. Age and ethnicity were unknown for around a quarter and a fifth of cases respectively, indicating that better recording of cases is necessary. Of the cases where age was known, the majority of victims were aged 18-25, with under 18s representing around a quarter of cases and under 16s around 1 in 10 of cases. Victims were mainly from Pakistani backgrounds (more than half of cases where ethnicity was known), followed by 'other ethnicity', Indian and Black African. Just over a half of referrals came to the attention of services through referral from other organisations, with under a third self-referrals and the remainder referred by friends or family. The interviews with the eight survivors of forced marriage echo the survey findings. The age range of when the forced marriage occurred was from 14-25. For five of the eight survivors the forced marriage was contracted with one survivor being forced into marriage twice. For two of the eight women, the experience of forced marriage was recent or ongoing (within the last two years). All the survivors interviewed were South Asian. All the women received help only when they came to Scotland - whether from abroad or another of the UK nations. Responding to forced marriage in Scotland Of the professionals interviewed, the majority had little direct experience of dealing with forced marriage but showed a sound understanding of forced marriage. However, those with direct experience of supporting victims of forced marriage had a deeper and more insightful understanding of forced marriage as a process rather than an 'event'. This was reflected at a policy level where there were differing levels of ownership and maturity of forced marriage policy, and where learning from forced marriage cases was identified as a means of improving responsiveness. Most professionals were aware that forced marriage took place in a range of communities, but it was seen as largely affecting South Asian communities in Scotland. This perception was confirmed by the survey findings, which found that the majority of cases where ethnicity was recorded related to South Asian communities. In both the policy analysis element of the study and in interviews with professionals, participants drew heavily from the Scottish Government's multi-agency guidance on forced marriage. A wide range of interventions are currently offered to support victims of forced marriage, most commonly one-to-one support, central to which is risk assessment and safety planning. Person-centred approaches were often used, and the need for therapeutic and practical support was also highlighted. Two third sector agencies interviewed offered mediation (and they were of the opinion that this was an effective intervention), despite the fact that Scottish multi-agency guidance stipulates that mediation should not be attempted in forced marriage cases. In terms of the outcome of support offered, nearly half of survey respondents reported that support offered was effective, but a further third were unsure whether the support offered was effective. Reported barriers to responding to forced marriage included 'race anxiety'; a need for more robust local authority procedures for supporting adult victims of forced marriage who have capacity (i.e. who do not meet the criteria to trigger access to adult protection); a need for further regular training for professionals; and a need for increased community education/public awareness on forced marriage. Multi-agency working was discussed both as very positive but also as a barrier - due to competing priorities and processes, with some agencies having more power than others to intervene and not always utilising the expertise available via specialists. A lack of training and learning opportunities on forced marriage was also identified as a barrier to responding effectively to forced marriage, despite forced marriage training being widely available. The survey results, policy analysis in some areas and interviews with some professionals suggest that a number of agencies and areas do not consider forced marriage a relevant issue for their organisation. This indicates that even with the provision of increased training on forced marriage, it might be challenging to recruit professionals to attend. Community education was thought to be a way to raise awareness within communities to increase reporting, but this intervention can also serve as a preventive measure. Targeted interventions for different sections of communities e.g. young people and elders would need to be developed. Although there was wide publicity about the forced marriage legislation, a lack of public awareness of forced marriage was also cited as a major barrier to increasing reporting and providing support for victims. This links with survivors' accounts that they sought help from family and friends and feared contacting agencies due to perceived confidentiality issues, family pressure, uncertainty about the appropriateness of response, and uncertainty about whether what had or was happening to them warranted agency involvement. There are examples of good practice at both a policy and practice level, including meaningful connections between child and adult protection leads and violence against women leads in some areas, proactive learning, person-centred support and in-depth expertise on forced marriage. Survivors reported that they had received excellent support from third sector organisations, but their accounts of other agencies were more mixed. Impact of interventions There was widespread support for civil remedies for dealing with Forced Marriage, from professionals interviewed and survivors of forced marriage. A number of issues were identified with regard to the implementation of civil remedies, relating to: a lack of consensus about what constitutes 'sufficient' evidence to justify granting a Forced Marriage Protection Order the onus of responsibility being placed on the victim, particularly where the victim is an adult who does not meet the criteria for accessing adult protection confidentiality of the victim not always being maintained In relation to criminalisation, most professionals interviewed thought it sent a strong message to the public that forced marriage was unacceptable in Scotland. However, a number of professionals (including some who supported criminalisation) also raised concerns about the potential for forced marriage to 'go underground', as victims would not wish to criminalise their families. It is too early to say whether this concern is justified. All survivors welcomed legal protection, but most were not supportive of criminalisation. However, one survivor who had pursued an FMPO stated that criminal procedures should be used, but only as a last resort. The impact of forced marriage on survivors of forced marriage included suicidal ideation, self-harm, eating disorders and other mental health problems. Survivors were frequently denied educational opportunities, impacting on their future careers and earning capacity. On a more positive note, survivors' experiences of forced marriage had engendered within them more liberal attitudes to parenting than those that they had experienced from their own parents. Survivors' experiences of statutory service response, including recent responses in Scotland, although positive in places, was patchy. However, it should be noted that some of the women were reflecting on historic cases stretching back a couple of decades and, at times, referring to experiences that happened outside Scotland. Most of the women had had some contact with third sector specialist women's support organisations, and all reported this as an extremely positive experience, although it should be noted that most survivors were recruited through their engagement with the women's sector. For some of the women, this was the first time they had told their story; for all of them it was the first time they had received support. Recommendations 1. Develop an innovative programme of further public/community awareness-raising activity, to prevent forced marriage and to encourage increased reporting 2. Develop further regular training on forced marriage for a range of professionals (including teachers, social workers, police officers, legal professionals and mental health practitioners), and ensure appropriate staff attend and the learning is cascaded and applied 3. Support the continued development of specialist women's sector organisations 4. Support the development of forced marriage policy in local authority areas, in order to increase ownership and consistency of approach at a local policy level throughout Scotland 5. Ensure that therapeutic and practical support is available to victims of forced marriage 6. Evaluate forced marriage interventions to develop better understandings of what types of forced marriage interventions work for whom 7. Address the issues the research identified in relation to implementing forced marriage legislation 8. Strengthen the statutory guidance of the Forced Marriage etc. (Protection and Jurisdiction) (Scotland) Act (2011) to make explicit local authorities' obligations to act in all cases of Forced Marriage 9. Improve record keeping of cases of forced marriage, as information about cases is key to developing learning and for future policy developmen

Environmental monitoring in the Mechara caves, Southeastern Ethiopia: implications for speleothem palaeoclimate studies

The interpretation of palaeoclimate records in speleothems depends on the understanding of the modern climate of the region, the geology, the hydrology above the caves, and the within-cave climate. Monitoring within-cave climate variability, geochemistry of speleothem-forming drip waters, and associated surface and groundwater, provides a modern baseline for interpretation of speleothem palaeohydrological and palaeoclimate records. Here, we present results of such monitoring of the Mechara caves in southeastern Ethiopia, conducted between 2004 and 2007. Results show nearly constant within-cave climate (temperature and humidity) in all caves, which generally reflects the surface climate. Groundwater and surface water geochemistry is similar across the region (except slight modification by local lithological variations) and modern drip water isotope data fall close to regional Meteoric Water Line, but speleothems further from equilibrium. Holocene and modern speleothems from these caves give high-resolution climate records, implying that the Mechara caves provide a suitable setting for the deposition of annually laminated speleothems that could record surface climate variability in a region where rainfall is sensitive to both the strength of the intertropical convergence zone as well as Indian Monsoon variability