The Role of Public Health Agencies in Addressing Child and Family Poverty: Public Health Nurses’ Perspectives

Poverty rates among child-bearing families in industrialised countries remain unacceptably high and have significant implications for population health. Both today and in the past, public health nurses have observed the impact of poverty on family health and well-being every day in their practice; yet, their perspectives on their role in addressing child and family poverty are currently absent from the literature. This paper presents findings of a qualitative descriptive study that explored perspectives of public health nurses in an urban Canadian setting about the impact of poverty on the well-being of children and families, and the potential roles of health organisations and public health nurses in addressing this issue. A key finding is the large gap between the role that nurses believe they can potentially play, and their current role. Barriers that public health nurses encounter when attempting to address poverty are identified, and implications of the findings for public health policy, practice, and research are discussed

Nurse Educators\u27 Perceptions of Ecoliteracy in Undergraduate Nursing Education

Introduction: Increased human health concerns related to the natural environment and climate change are having a growing impact on nursing practice. This past year in Canada, for example, British Columbia reported the highest number of heat related deaths, followed by devasting forest fires in many provinces that have disproportionately impacted Indigenous Peoples. Nurses are well positioned to address the direct health impacts associated with climate change. As a result, nurses require an increased level of ecoliteracy to address the health impacts linked to climate change. The role of the nurse in addressing the health impacts of climate change are vast, ranging from direct patient care, education and advocacy, their role includes supporting individuals, communities, and populations to mitigate, adapt and build resiliency in the face of a changing climate. Background: Regulatory and professional associations support the professional emphasis on the significance of ecoliteracy yet there is insufficient understanding of the resistance to the content in nursing curricula. Although current literature supports an increased emphasis on the integration of ecosystem health concerns and the impact on human health within undergraduate nursing education, there is a paucity of empirical evidence regarding nursing educators’ perspectives on the subject. This study is a first step in gaining a greater understanding of the perspectives of nurse educators on ecoliteracy within undergraduate nursing education programs in one Canadian province. Methods: This qualitative research study included 13 nurse educators from three diverse academic settings. Data were collected using semi-structured, open-ended interview questions, followed by content analysis of the data. Results: Data analysis revealed five key themes: 1) Importance of ecoliteracy in undergraduate nursing programs; 2) Current integration of ecoliteracy concepts in curricula; 3) Future considerations for ecoliteracy content; 4) Barriers to the inclusion of content supportive of ecoliteracy in curricula; 5) Strategies to address barriers. While educators feel that ecoliteracy is important in undergraduate nursing, they noted that the current integration of climate content in the curriculum is uneven. Barriers and potential strategies to integrating this content are identified. Conclusion: The findings of this study can be used for curriculum revision and to stimulate innovation and research in nursing education. This study creates the opportunity for a larger scale replication study, pilot studies of the integration of concepts that would support ecoliteracy, and further research on the topic. This study identified that many complexities are involved in achieving ecoliteracy in nursing education and suggest that while threading of content can address the urgent need, further research is required to identify entry to practice requirements for undergraduate nursing programs. Résumé Introduction : Les préoccupations grandissantes associées aux liens entre la santé humaine, l’environnement naturel et les changements climatiques touchent de plus en plus la pratique infirmière. Au cours de la dernière année au Canada, la Colombie-Britannique a signalé le plus grand nombre de décès liés à la chaleur, suivie par des incendies de forêt dévastateurs dans de nombreuses provinces qui ont affecté de manière disproportionnée les peuples autochtones. Les infirmières sont bien placées pour faire face aux impacts directs des changements climatiques sur la santé, et doivent donc avoir un niveau plus élevé d’écolittératie afin de composer avec les impacts des changements climatiques sur la santé. Le rôle de l’infirmière dans la lutte contre les impacts du changement climatique sur la santé est vaste, allant des soins directs aux patients, à la formation et à la défense des droits, et comprenant le soutien aux individus, aux communautés et aux populations pour atténuer, favoriser l’adaptation et renforcer la résilience par rapport au changement climatique. Contexte : Les associations réglementaires et professionnelles appuient l’accent mis par les professionnels sur l’importance de l’écolittératie, mais la compréhension de la résistance au contenu des programmes d’études en sciences infirmières est insuffisante. Bien que la littérature actuelle appuie l’importance accrue accordée à l’intégration des préoccupations liées à la santé des écosystèmes et à l’impact sur la santé humaine dans la formation en sciences infirmières au premier cycle, il existe peu de résultats empiriques concernant les perceptions des infirmières enseignantes sur le sujet. Cette étude représente une première étape pour mieux comprendre leurs perspectives sur l’écolittératie dans le cadre des programmes de formation en sciences infirmières au premier cycle dans une province canadienne. Méthode : Cette recherche qualitative incluait 13 infirmières enseignantes de 3 milieux universitaires différents. Les données ont été recueillies à l’aide de questions ouvertes lors d’entrevues semi-structurées, suivies d’une analyse de contenu. Résultats : L’analyse des données a dévoilé cinq thèmes clés : 1) L’importance de l’écolittératie dans les programmes en sciences infirmières de premier cycle; 2) Le niveau actuel d’intégration des notions d’écolittératie au sein des programmes d’études; 3) Les considérations pour l’ajout de contenu en matière d’écolittératie à l’avenir; 4) Les obstacles à l’inclusion de contenus favorables à l’écolittératie dans les programmes d’études; et, 5) Les stratégies pour franchir ces obstacles. Bien que les enseignantes estiment que l’écolittératie est importante en sciences infirmières au premier cycle, elles ont noté que l’intégration actuelle de contenu lié au climat dans les programmes d’études est inégale. Les obstacles et les stratégies potentielles à l’intégration de ce contenu sont identifiés. Conclusion : Les résultats de cette étude peuvent servir pour la révision des programmes et pour stimuler l’innovation et la recherche en formation en sciences infirmières. Cette étude crée l’occasion de refaire l’étude à plus grande échelle, de proposer des études pilotes sur l’intégration de concepts qui soutiendraient l’écolittératie et d’autres recherches sur le sujet. Cette étude a mis en évidence de nombreuses complexités qu’implique l’atteinte de l’écolittératie dans la formation en sciences infirmières et suggère que même si la mise en place du contenu peut répondre au besoin urgent, des recherches supplémentaires sont nécessaires pour déterminer les exigences d’entrée à la pratique au terme des programmes de sciences infirmières de premier cycle

'This was a Conradian world I was entering': Postcolonial river-journeys beyond the Black Atlantic in Caryl Phillips's work

Caryl Phillips has been accused of replicating the stereotyped view of a timeless, ahistorical Africa that Paul Gilroy puts forward in his paradigm of the Black Atlantic. Yet this article shows that Crossing the River and Phillips’s essays about Africa suggest ways in which Gilroy’s important paradigm of the black Atlantic could be broadened to become more inclusive of writing about Africa. Phillips draws inspiration from writers such as V S Naipaul, Chinua Achebe, and especially Joseph Conrad, to update the literary journey upriver and make it relevant to contemporary West African issues. A complex interplay of racial identities occurs when people from the African diaspora travel to Africa; this is a key preoccupation for Phillips when he rewrites Conrad. During the course of his river-journeys, Phillips meditates upon the complexities of being a black Westerner in Africa, examines the memory of slavery, colonialism and postcolonial unrest, problematises diasporan attempts to ‘return’ to Africa, and recognises the longstanding modernity of African countries

Development and Validation of a Composite Programmatic Assessment Tool for HIV Therapy

Background We developed and validated a new and simple metric, the Programmatic Compliance Score (PCS), based on the IAS-USA antiretroviral therapy management guidelines for HIV-infected adults, as a predictor of all-cause mortality, at a program-wide level. We hypothesized that non-compliance would be associated with the highest probability of mortality. Methods and Findings 3543 antiretroviral-naive HIV-infected patients aged ≥19 years who initiated antiretroviral therapy between January 1, 2000 and August 31, 2009 in British Columbia (BC), Canada, were followed until August 31, 2010. The PCS is composed by six non-performance indicators based on the IAS-USA guidelines: (1) having <3 CD4 count tests in the first year after starting antiretroviral therapy; (2) having <3 plasma viral load tests in the first year after starting antiretroviral therapy; (3) not having drug resistance testing done prior to starting antiretroviral therapy; (4) starting on a non-recommended antiretroviral therapy regimen; (5) starting therapy with CD4 <200 cells/mm3; and (6) not achieving viral suppression within 6 months since antiretroviral therapy initiation. The sum of these six indicators was used to develop the PCS score - higher score indicates poorer performance. The main outcome was all-cause mortality. Each PCS component was independently associated with mortality. In the mortality analysis, the odds ratio (OR) for PCS ≥4 versus 0 was 22.37 (95% CI 10.46–47.84). Conclusions PCS was strongly associated with all-cause mortality. These results lend independent validation to the IAS-USA treatment guidelines for HIV-infected adults. Further efforts are warranted to enhance the PCS as a means to further improve clinical outcomes. These should be specifically evaluated and targeted at healthcare providers and patients

Application and Validation of Case-Finding Algorithms for Identifying Individuals with Human Immunodeficiency Virus from Administrative Data in British Columbia, Canada

Objective To define a population-level cohort of individuals infected with the human immunodeficiency virus (HIV) in the province of British Columbia from available registries and administrative datasets using a validated case-finding algorithm. Methods Individuals were identified for possible cohort inclusion from the BC Centre for Excellence in HIV/AIDS (CfE) drug treatment program (antiretroviral therapy) and laboratory testing datasets (plasma viral load (pVL) and CD4 diagnostic test results), the BC Centre for Disease Control (CDC) provincial HIV surveillance database (positive HIV tests), as well as databases held by the BC Ministry of Health (MoH); the Discharge Abstract Database (hospitalizations), the Medical Services Plan (physician billing) and PharmaNet databases (additional HIV-related medications). A validated case-finding algorithm was applied to distinguish true HIV cases from those likely to have been misclassified. The sensitivity of the algorithms was assessed as the proportion of confirmed cases (those with records in the CfE, CDC and MoH databases) positively identified by each algorithm. A priori hypotheses were generated and tested to verify excluded cases. Results A total of 25,673 individuals were identified as having at least one HIV-related health record. Among 9,454 unconfirmed cases, the selected case-finding algorithm identified 849 individuals believed to be HIV-positive. The sensitivity of this algorithm among confirmed cases was 88%. Those excluded from the cohort were more likely to be female (44.4% vs. 22.5%; p<0.01), had a lower mortality rate (2.18 per 100 person years (100PY) vs. 3.14/100PY; p<0.01), and had lower median rates of health service utilization (days of medications dispensed: 9745/100PY vs. 10266/100PY; p<0.01; days of inpatient care: 29/100PY vs. 98/100PY; p<0.01; physician billings: 602/100PY vs. 2,056/100PY; p<0.01). Conclusions The application of validated case-finding algorithms and subsequent hypothesis testing provided a strong framework for defining a population-level cohort of HIV infected people in BC using administrative databases

Perfectionism, burnout and engagement in youth sport: The mediating role of basic psychological needs

© 2016 Elsevier Ltd. Recent research indicates perfectionistic concerns and perfectionistic strivings share divergent associations with athlete burnout and athlete engagement. Guided by self-determination theory, the present study examined whether these associations were explained by basic psychological needs. Youth athletes (n = 222, M age = 16.01, SD = 2.68) completed measures of multidimensional perfectionism, athlete burnout, athlete engagement, basic psychological need satisfaction and thwarting. Structural equation modelling revealed that basic psychological need satisfaction and thwarting mediated the perfectionism-engagement and perfectionism-burnout relationships. Perfectionistic concerns shared a negative relationship (via need satisfaction) with athlete engagement and a positive relationship (via need satisfaction and thwarting) with athlete burnout. In contrast, perfectionistic strivings shared a positive relationship (via need satisfaction) with athlete engagement and a negative relationship (via need satisfaction and thwarting) with athlete burnout. The findings highlight the role of basic psychological needs in explaining the differential associations that perfectionistic concerns and strivings share with athlete burnout and engagement

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure