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

Kebijakan Tentang Partisipasi Perempuan dalam Konsesi Hutan

Berdasarkan penelitian Women Research Institute di Kabupaten Siak dan Pelalawan, Provinsi Riau, partisipasi perempuan belum banyak diperhitungkan dalam proses pengambilan keputusan tentang konsesi hutan. Walaupun pada Kenyataannya perempuan memiliki peran yang besar dalam pengelolaan hutan. Pemerintah juga belum memberikan perhatian khusus terhadap keterlibatan perempuan sebagaimana tercermin dalam kebijakan tentang konsesi hutan yang tidak memberikan ruang bagi partisipasi perempuan. Diantara 20 peraturan tentang konsesi hutan yang memandatkan partisipasi publik, hanya satu peratur-an yang secara khusus mewajibkan adanya partisipasi perempuan yaitu Undang-Undang Nomor 7 Tahun 2012 tentang Penanganan Konflik Sosial. Berdasarkan undang-undang tersebut, konflik sosial yang seringkali muncul akibat konsesi hutan perlu ditangani dengan berlandaskan asas kesetaraan gender. Artinya, baik laki-laki maupun perempuan harus diberikan kesempatan dan hak yang sama untuk ber-partisipasi. Asas kesetaraan gender dalam penanganan konflik sosial tercermin dengan adanya pelibatan masyarakat baik laki-laki maupun perempuan dalam upaya-upaya penyelesaian konflik. Selain melibatkan masyarakat secara umum, Undang-Undang Nomor 7 Tahun 2012 juga mengatur pembentukan Satuan Tugas Penyelesaian Konflik Sosial sebagai salah satu upaya mengatasi masalah konflik sosial. Lebih lanjut, peraturan ini mewajibkan adanya pelibatan perempuan dalam Satuan Tugas Penyelesaian Konflik Sosial sekurangnya-kurangnya 30% dari jumlah anggota. Perempuan diharapkan terlibat dalam mengatasi permasalahan sosial yang terjadi di lingkungannya, khususnya dalam penanganan konflik sosial

Crisis Decision-Making During Hurricane Sandy: An Analysis of Established and Emergent Disaster Response Behaviors in the New York Metro Area

Objective This collective case study examined how and why specific organizational decision-making processes transpired at 2 large suburban county health departments in lower New York State during their response to Hurricane Sandy in 2012. The study also examined the relationships that the agencies developed with other emerging and established organizations within their respective health systems. Methods In investigating these themes, the authors conducted in-depth, one-on-one interviews with 30 senior-level public health staff and first responders; reviewed documentation; and moderated 2 focus group discussions with 17 participants. Results Although a natural hazard such as a hurricane was not an unexpected event for these health departments, they nevertheless confronted a number of unforeseen challenges during the response phase: prolonged loss of power and fuel, limited situational awareness of the depth and breadth of the storm’s impact among disaster-exposed populations, and coordination problems with a number of organizations that emerged in response to the disaster. Conclusions Public health staff had few plans or protocols to guide them and often found themselves improvising and problem-solving with new organizations in the context of an overburdened health care system

Frailty, cognitive impairment and anticoagulation among older adults with non-valvular atrial fibrillation

BACKGROUND/OBJECTIVES Oral anticoagulation (OAC) is challenging in older patients with nonvalvular atrial fibrillation (NVAF) who are often frail and have cognitive impairment. We examined the characteristics of older NVAF patients associated with higher odds of physical and cognitive impairments. We also examined if these high-risk patients have different OAC prescribing patterns and their satisfaction with treatment because it may impact optimal management of their NVAF. METHODS The patients in the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF study cohort 2016–2018) had NVAF, were aged 65 and older, and eligible for the receipt of OAC. Measures included frailty (Fried Frailty scale), cognitive impairment (Montreal Cognitive Assessment Battery), OAC prescribing and type (direct oral anticoagulant [DOAC] or vitamin K antagonist [VKA]), depressive symptoms (Patient Health Questionnaire-9), bleeding, stroke risk, and treatment benefit (Anti-Clot Treatment Scale). RESULTS Patients (n = 1,244) were 49% female, aged 76 (standard deviation = 7) years. A total of 14% were frail, and 42% had cognitive impairment. Frailty and cognitive impairment co-occurred in 9%. Odds of having both impairments versus none were higher with depression (odds ratio [OR] = 4.62; 95% confidence interval [CI] = 2.59–8.26), older age (OR = 1.56; 95% CI = 1.29–1.88), lower education (OR = 3.81; 95%CI = 2.13–6.81), race/ethnicity other than non-Hispanic White (OR = 7.94; 95% CI = 4.34–14.55), bleeding risk (OR = 1.43; 95% CI = 1.12–1.81), and stroke risk (OR = 1.35; 95% CI = 1.13–1.62). OAC prescribing was not associated with CI and frailty status. Among patients taking OACs (85%), those with both impairments were more likely to take DOAC than VKA (OR = 1.69; 95% CI = 1.01–2.80). Having both impairments (OR = 1.87; 95% CI = 1.08–3.27) or cognitive impairment (OR = 1.56; 95% CI = 1.09–2.24) was associated with higher odds of reporting lower treatment benefit. CONCLUSION In a large cohort of older NVAF patients, half were frail or cognitively impaired, and 9% had both impairments. We highlight the characteristics of patients who may benefit from cognitive and physical function screenings to maximize treatment and enhance prognosis. Finally, the co-occurrence of impairment was associated with low perceived benefit of treatment that may impede optimal management

Proteomics Reveal a Concerted Upregulation of Methionine Metabolic Pathway Enzymes, and Downregulation of Carbonic Anhydrase-III, in Betaine Supplemented Ethanol-Fed Rats

We employed a proteomic profiling strategy to examine the effects of ethanol and betaine diet supplementation on major liver protein level changes. Male Wistar rats were fed control, ethanol or betaine supplemented diets for 4 weeks. Livers were removed and liver cytosolic proteins resolved by onedimensional and two-dimensional separation techniques. Significant upregulation of betaine homocysteine methyltransferase-1, methionine adenosyl transferase-1, and glycine N-methyltransferase were the most visually prominent protein changes observed in livers of rats fed the betaine supplemented ethanol diet. We hypothesise that this concerted upregulation of these methionine metabolic pathway enzymes is the protective mechanism by which betaine restores a normal metabolic ratio of liver S-adenosylmethionine to S-adenosylhomocysteine. Ethanol also induced significant downregulation of carbonic anhydrase- III protein levels which was not restored by betaine supplementation. Carbonic anhydrase-III can function to resist oxidative stress, and we therefore hypothesise that carbonic anhydrase-III protein levels compromised by ethanol consumption, contribute to ethanol-induced redox stress

Psychosocial and cognitive multimorbidity and health-related quality of life and symptom burden in older adults with atrial fibrillation: The systematic assessment of geriatric elements in atrial fibrillation (SAGE-AF) cohort study

BACKGROUND: Depression, anxiety, and cognitive impairments occur in up to 40 % of adults with AF and are associated with poorer health-related quality of life (HRQoL) and higher symptom burden. However, it is unknown how often these impairments co-occur, or multimorbidity, and how multimorbidity effects HRQoL and symptom burden. METHODS: Patients with AF age \u3e /=65 years with a CHA2DS2VASC risk score \u3e /= 2 and eligible for oral anticoagulation therapy were recruited from five clinics in a prospective cohort study. Participants completed validated measures of depression (PHQ9) and anxiety (GAD7), cognitive impairment (MoCA), and HRQOL and AF symptom burden (AFEQT). Multinomial logistic regression was used. RESULTS: Participants (N = 1244, 49 % female) were on average 76 +/- 7 years; 86 % were non-Hispanic white. Approximately 35 % of participants had 1 impairment, 17 % had 2 impairments and 8% had 3 impairments; 39 % had none of the 3 impairments examined. Compared to participants with no impairments, patients with 1, 2 and 3 impairments had higher odds of poor HRQoL (adjusted OR [AOR] = 1.77, 95 % CI 1.21, 2.60; AOR = 6.64, 95 % CI 4.43, 9.96; and AOR = 7.50, 95 % CI 4.40, 12.77, respectively) and those with 2 and 3 impairments had higher odds of high symptom burden (AOR = 3.69 95 % CI 2.22, 6.13; and AOR = 5.41 95 % CI 2.85, 10.26). CONCLUSIONS: Psychosocial/cognitive multimorbidity is common among older adults with AF and is associated with poor HRQoL and high symptom burden. Clinicians might consider incorporating psychosocial and cognitive screens into routine care as this may identify a high-risk population