Developing family-based care : complexities in implementing the UN guidelines for the alternative care of children

In response to immense challenges facing children in out-of-home care in all parts of the world, there is a growing international trend towards the development of family-based placements for children in out-of-home care, away from large-scale institutions. This development of family based care within a range of care options is recommended within the international Guidelines for the Alternative Care of Children (the Guidelines), which were welcomed unanimously by the United Nations General Assembly in 2009. This paper offers an overview of these guidelines’ key principles, and considers the complexities that arise in efforts towards their implementation. Drawing on the literature, supported by research that informed Moving forward (the implementation handbook on the Guidelines) and illustrated by practice examples from across global regions, the authors examine three fundamental challenges in States’ efforts to implement the Guidelines’ ‘suitability’ principle, namely: de-institutionalising the care system; financing suitable family-based care and supporting the suitability of kinship care. The paper critically reflects on de-institutionalised systems and practices, and the cross-cultural assumptions about suitable foster and kinship care that emerge in efforts towards de-institutionalisation; it aims to spark new thinking on strategic ways in which alternative care is planned and delivered, to impact on future practice

Evaluating Importation of Aquatic Ornamental Species for Biosecurity Purposes

The aquatic ornamental species (AOS) trade is a significant pathway for the introduction and establishment of non-indigenous species into aquatic environments. The likelihood of such occurrences is expected to increase worldwide as industry growth continues and warmer conditions emerge under future climate scenarios. This study used recent (2015 – 2019) New Zealand importation data to determine the composition, diversity, abundance, and arrival frequency of AOS. Our analysis revealed that ca. 300,000 aquatic ornamental individuals are imported annually to New Zealand, with freshwater fish comprising 98% of import quantities. Despite the relatively small market size, the estimated AOS diversity of 865 taxa (89 and 9.5% identified to species and genus level, respectively) is comparable to larger markets with ∼60% of taxa being of marine origin. Species (n = 20) for further investigation were prioritized based on quantity and frequency of import. These prioritized AOS were exclusively tropical and subtropical freshwater fish and align with the most frequently imported AOS globally, including the top three: neon tetra (Paracheirodon innesi), guppy (Poecilia reticulata), and tiger barb (Puntigrus tetrazona). Species distribution modeling of the 20 prioritized AOS predicted that 13 species are suitable for New Zealand’s current climate conditions, most notably sucker-belly loach (Pseudogastromyzon myersi), white cloud mountain minnow (Tanichthys albonubes), and golden otocinclus (Macrotocinclus affinis). Potential changes in habitat suitability were predicted under future climate scenarios, with largest increases (29%) for Po. reticulata. The described approach provides an adaptable framework to assess establishment likelihood of imported AOS to inform regulatory decision making

Depression and Clinical Inertia in Patients With Uncontrolled Hypertension

Depression is a known risk factor for poor prognosis among patients with cardiovascular disease.1 Numerous biological and behavioral mechanisms have been proposed.2 However, few studies have investigated the association between depression and “clinical inertia,” or lack of treatment intensification in individuals not at evidence-based goals for care.3 To address this gap, we assessed whether a diagnosis of depression is associated with clinical inertia in patients with uncontrolled hypertension

Palliative care needs in patients hospitalized with heart failure (PCHF) study: rationale and design

Abstract Aims The primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes. Methods An unselected, prospective, near-consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2-year period. All potential participants will be screened using B-type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease-specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed. Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF

Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes

Background: The persistence of depressive symptoms after hospitalization is a strong risk factor for mortality after acute coronary syndromes (ACS). Poor adherence to secondary prevention behaviors may be a mediator of the relationship between depression and increased mortality. Objective: To determine whether rates of adherence to risk reducing behaviors were affected by depressive status during hospitalization and 3 months later. Design: Prospective observational cohort study. Setting: Three university hospitals. Participants: Five hundred and sixty patients were enrolled within 7 days after ACS. Of these, 492 (88%) patients completed 3-month follow-up. Measurements: We used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and 3 months after discharge. We assessed adherence to 5 risk-reducing behaviors by patient self-report at 3 months. We used χ2 analysis to compare differences in adherence among 3 groups: persistently nondepressed (BDI<10 at hospitalization and 3 months); remittent depressed (BDI ≥10 at hospitalization; <10 at 3 months); and persistently depressed patients (BDI ≥10 at hospitalization and 3 months). Results: Compared with persistently nondepressed, persistently depressed patients reported lower rates of adherence to quitting smoking (adjusted odds ratio [OR] 0.23, 95% confidence interval [95% CI] 0.05 to 0.97), taking medications (adjusted OR 0.50, 95% CI 0.27 to 0.95), exercising (adjusted OR 0.57, 95% CI 0.34 to 0.95), and attending cardiac rehabilitation (adjusted OR 0.5, 95% CI 0.27 to 0.91). There were no significant differences between remittent depressed and persistently nondepressed patients. Conclusions: Persistently depressed patients were less likely to adhere to behaviors that reduce the risk of recurrent ACS. Differences in adherence to these behaviors may explain in part why depression predicts mortality after ACS. Key Words: cardiovascular diseases, depression, medication adherence, prevention, self car

Assessing the feasibility of mobilisation of C0–C3 cervical segments to reduce headache in migraineurs

Background: Migraine headache poses a major public health problem. Pharmacological treatment is the most common management strategy, however patients are increasingly seeking alternative treatments. The Watson Headache® Approach (targeted and sustained non-manipulative mobilisation on C0–C3) is used to reduce headache symptoms and provide sustained relief. This research aimed to assess this approach as a treatment strategy for migraine headache and to provide data to inform a subsequent randomised controlled trial. Methods: One-hundred-and-one migraineurs were randomised to either the ‘treat now’ (n=54) or ‘wait list’ (n=47) group. Physiotherapists trained in the approach provided the intervention. Participants received six sessions. Outcome data were collected as a headache diary, including: headache score, headache days, headache duration, pain and medication use. Follow up was immediately post treatment (FU0) and at 3 (FU3), 6 (FU6) and 12 months (FU12). Results: Between-group analysis found no difference between the wait list group at baseline 2 and the treat now group at FU0 for any of the variables of interest. Within-group analysis found that after treatment participants experienced a reduction in headache intensity (P=0.007) and duration (P<0.001), had fewer headache days/28 days (P<0.001), hours of severe migraine headache (P<0.001) and used 20% fewer medications compared with before treatment (P<0.001). Conclusion: The Watson Headache® Approach shows promise as a potential strategy for migraine management, however further work is required to assess the efficacy of this technique in a larger, randomised placebo-controlled trial. Future studies should aim to identify those most likely to benefit from treatment and who may be at risk of potential adverse event

Differential effects of biological invasions on coastal blue carbon: A global review and meta‐analysis

Human‐caused shifts in carbon (C) cycling and biotic exchange are defining characteristics of the Anthropocene. In marine systems, saltmarsh, seagrass, and mangrove habitats—collectively known as “blue carbon” and coastal vegetated habitats (CVHs) —are a leading sequester of global C and increasingly impacted by exotic species invasions. There is growing interest in the effect of invasion by a diverse pool of exotic species on C storage and the implications for ecosystem‐based management of these systems. In a global meta‐analysis, we synthesized data from 104 papers that provided 345 comparisons of habitat‐level response (plant and soil C storage) from paired invaded and uninvaded sites. We found an overall net effect of significantly higher C pools in invaded CVHs amounting to 40% (±16%) higher C storage than uninvaded habitat, but effects differed among types of invaders. Elevated C storage was driven by blue C‐forming plant invaders (saltmarsh grasses, seagrasses, and mangrove trees) that intensify biomass per unit area, extend and elevate coastal wetlands, and convert coastal mudflats into C‐rich vegetated habitat. Introduced animal and structurally distinct primary producers had significant negative effects on C pools, driven by herbivory, trampling, and native species displacement. The role of invasion manifested differently among habitat types, with significant C storage increases in saltmarshes, decreases in seagrass, and no significant effect in mangroves. There were also counter‐directional effects by the same species in different systems or locations, which underscores the importance of combining data mining with analyses of mean effect sizes in meta‐analyses. Our study provides a quantitative basis for understanding differential effects of invasion on blue C habitats and will inform conservation strategies that need to balance management decisions involving invasion, C storage, and a range of other marine biodiversity and habitat functions in these coastal systems

Improving the science-policy dialogue to meet the challenges of biodiversity conservation: having conversations rather than talking at one-another

A better, more effective dialogue is needed between biodiversity science and policy to underpin the sustainable use and conservation of biodiversity. Many initiatives exist to improve communication, but these largely conform to a ‘linear’ or technocratic model of communication in which scientific “facts” are transmitted directly to policy advisers to “solve problems”. While this model can help start a dialogue, it is, on its own, insufficient, as decision taking is complex, iterative and often selective in the information used. Here, we draw on the literature, interviews and a workshop with individuals working at the interface between biodiversity science and government policy development to present practical recommendations aimed at individuals, teams, organisations and funders. Building on these recommendations, we stress the need to: (a) frame research and policy jointly; (b) promote inter- and trans-disciplinary research and “multi-domain” working groups that include both scientists and policy makers from various fields and sectors; (c) put in place structures and incentive schemes that support interactive dialogue in the long-term. These are changes that are needed in light of continuing loss of biodiversity and its consequences for societal dependence on and benefits from nature

The Canadian celiac health survey – the Ottawa chapter pilot

BACKGROUND: Celiac disease may manifest with a variety of symptoms which can result in delays in diagnosis. Celiac disease is associated with a number of other medical conditions. The last national survey of members of the Canadian Celiac Association (CCA) was in 1989. Our objective was to determine the feasibility of surveying over 5,000 members of the CCA, in addition to obtaining more health related information about celiac disease. METHODS: The Professional Advisory Board of the CCA in collaboration with the University of Ottawa developed a comprehensive questionnaire on celiac disease. The questionnaire was pre-tested and then a pilot survey was conducted on members of the Ottawa Chapter of the CCA using a Modified Dillmans' Total Design method for mail surveys. RESULTS: We had a 76% response to the first mailout of the questionnaire. The mean age of participants was 55.5 years and the mean age at diagnosis was 45 years. The majority of respondents presented with abdominal pain, diarrhea, fatigue or weight loss. Prior to diagnosis, 30% of respondents consulted four or more family doctors. Thirty seven percent of individuals were told they had either osteoporosis or osteopenia. Regarding the impact of the gluten-free diet (GFD), 45% of individuals reported that they found following a GFD was very or moderately difficult. The quality of life of individuals with celiac disease was comparable to the mean quality of life of Canadians. CONCLUSION: On the basis of our results, we concluded that a nationwide survey is feasible and this is in progress. Important concerns included delays in the diagnosis of celiac disease and the awareness of associated medical conditions. Other issues include awareness of celiac disease by health professionals and the impact of the GFD on quality of life. These issues will be addressed further in the national survey