Providing Care for Many in the Context of Few Resources: Secondary Traumatic Stress, Burnout and Moral Distress Experienced by Healthcare Providers in Rural Uganda

In the context of the global nursing shortage, and particularly in low-resource settings, nurses are at an increased risk for work-related stress problems like secondary traumatic stress (STS), burnout, and moral distress. These three work-related mental health consequences, sometimes associated with absenteeism and intent to leave the profession, could potentially contribute further to the shortage of nurses. This two-part study is a longitudinal examination of the work-related mental health consequences experienced by healthcare providers in rural Uganda. In Study 1, participants (n=208; 159 students and 49 experienced health workers) completed self-report, psychosocial measures at baseline and 134 of the students completed the measures again 13-months later. Study 1, which was primarily quantitative, assessed the prevalence of mental health consequences and common coping strategies and examined associations among coping strategies and symptoms over time. In Study 2, participants (n=13) completed in-depth qualitative interviews about their experiences as healthcare providers. Qualitative data from both studies were used to contextualize and illustrate quantitative findings. Almost all participants endorsed clinically significant symptoms of at least STS, burnout or moral distress. Participants reported most commonly utilizing religion, planning, and other active, problem-focused coping strategies such as improvising in order to cope with challenging work circumstances. However, based on follow-up data for students, symptoms of STS and burnout were stable across the 13 months and individual differences in coping strategies had little effect on the progression of symptoms. Findings underscore the need for increased mental health awareness and targeted stress reduction programs in addition to infrastructural changes within the healthcare and health education systems in rural Uganda and other low-resource settings. The implications and suggestions are discussed in light of Uganda’s cultural context and plans for development

Women Incarcerated in Rural Southern Prisons in the United States: A Review of Existing Multidisciplinary Literature and Suggestions for Future Directions

Prisons in the Southern United States are a particularly unique kind of rural institutions not only because of their geographic locations, social climates informed by the rural cultures of staff and prisoners, and, for many older Southern prisons, their roots in plantation agriculture. Despite these realities, rural criminology has yet to systematically synthesize and explore what existing research indicates about the everyday lives of over 30,000 women currently serving time in state prisons throughout the Southern United States. The present study attempts to fill this gap in the literature by synthesizing all the available literature on women incarcerated in rural Southern prisons and identifying four prevailing themes in this body of work: regional culture in historical context, relationships and social dynamics, victimization and wellbeing, and journeys through the system from sentencing to reentry.&nbsp

LEGISLATIVE UPDATE

The Legislative Update is compiled and written annually by the Journal of Dispute Resolution’s Associate Members under the direction of the Associate Editor in Chief. It is designed to provide readers with a listing of pertinent legislation affecting the field of alternative dispute resolution (“ADR”) and a more detailed look at certain bills because of their importance or novelty within the field

Economic Evaluation Plan (EEP) for A Very Early Rehabilitation Trial (AVERT): An international trial to compare the costs and cost-effectiveness of commencing out of bed standing and walking training (very early mobilization) within 24 h of stroke onset with usual stroke unit care

Rationale: A key objective of A Very Early Rehabilitation Trial is to determine if the intervention, very early mobilisation following stroke, is cost-effective. Resource use data were collected to enable an economic evaluation to be undertaken and a plan for the main economic analyses was written prior to the completion of follow up data collection. Aim and hypothesis To report methods used to collect resource use data, pre-specify the main economic evaluation analyses and report other intended exploratory analyses of resource use data. Sample size estimates: Recruitment to the trial has been completed. A total of 2,104 participants from 56 stroke units across three geographic regions participated in the trial. Methods and design: Resource use data were collected prospectively alongside the trial using standardised tools. The primary economic evaluation method is a cost-effectiveness analysis to compare resource use over 12 months with health outcomes of the intervention measured against a usual care comparator. A cost-utility analysis is also intended. Study outcome: The primary outcome in the cost-effectiveness analysis will be favourable outcome (modified Rankin Scale score 0-2) at 12 months. Cost-utility analysis will use health-related quality of life, reported as quality-adjusted life years gained over a 12 month period, as measured by the modified Rankin Scale and the Assessment of Quality of Life. Discussion: Outcomes of the economic evaluation analysis will inform the cost-effectiveness of very early mobilisation following stroke when compared to usual care. The exploratory analysis will report patterns of resource use in the first year following stroke

Pesquisa nas fronteiras da comunidade-universidade: Uso da ciência pública para estudar vigilância policial no South Bronx

This article is a case study of the Morris Justice Project (MJP), a participatory action research (PAR) study in a South Bronx neighborhood of New York City (NYC) designed to understand residents’ experiences with and attitudes towards the New York Police Department (NYPD). An illustration of public science, the research was conducted in solidarity with an emerging police reform movement and in response to an ongoing and particularly aggressive set of policing policies that most heavily impacts poor communities and communities of color.  The case study describes a set of ongoing participatory, research-action, “sidewalk science” strategies, developed in 42 square blocks of the South Bronx, designed to better understand and challenge the ongoing structural violence of the carceral state. Collaboratively written with members of the Morris Justice collective, we tell our story across three sections that outline the genesis of the project, describe our major commitments, and offers PAR and public science as a possible “intervention” in traditional university practice.Este artículo es un estudio de caso del Proyecto de Morris Justice (MJP), un estudio de investigación de acción participativa (PAR) en un vecindario del South Bronx de la Ciudad de Nueva York (NYC) diseñado para comprender las experiencias y las actitudes de los residentes hacia Departamento de Policía de Nueva York (NYPD). Una ilustración de la ciencia pública, la investigación se llevó a cabo en solidaridad con un movimiento de reforma policial emergente y en respuesta a un conjunto de políticas policiales en curso y particularmente agresivo que afecta más a las comunidades pobres y las comunidades de color. El estudio de caso describe un conjunto de estrategias participativas en curso, de investigación-acción, “ciencia de acera”, desarrolladas en 42 bloques cuadrados del South Bronx, diseñadas para comprender mejor y desafiar la violencia estructural en curso del estado carceral. Escrito en colaboración con miembros del colectivo Morris Justice, contamos nuestra historia en tres secciones que resumen la génesis del proyecto, describimos nuestros principales compromisos y ofrecemos PAR y ciencia pública como una posible “intervención” en la práctica universitaria tradicional.Este artigo é um estudo de caso do Morris Justice Project (MJP), um estudo de pesquisa de ação participativa (PAR) em um bairro no South Bronx, em Nova York, projetado para entender as experiências e atitudes dos moradores em relação ao Departamento de Polícia de Nova York (NYPD). Uma ilustração da ciência pública, a pesquisa foi conduzida em solidariedade com um movimento emergente de reforma da polícia e em resposta a um conjunto de políticas policiais em andamento e particularmente agressivas que mais afetam comunidades pobres e comunidades de cor. O estudo de caso descreve um conjunto de estratégias participativas de pesquisa-ação, “ciência da calçada”, desenvolvidas em 42 quarteirões do South Bronx, destinadas a melhor compreender e desafiar a violência estrutural em curso no Estado carcerário. Escrito em colaboração com membros do coletivo Morris Justice, contamos nossa história em três seções que resumem a gênese do projeto, descrevem nossos principais compromissos e oferecem a PAR e a ciência pública como uma possível “intervenção” na prática universitária tradicional.

The suitability and acceptability of a co-designed prototype psychoeducational activity book for seven- to eleven-year-olds with ADHD

Young people with Attention Deficit Hyperactivity Disorder (ADHD) can benefit from psychoeducation interventions. Co-design of these interventions increases engagement and impact. However, there are very few age-appropriate co-designed psychoeducational resources for young people with ADHD. Therefore an activity book prototype (‘ADHD Hero Activity Book’) was co-designed to teach 7–11-year-olds with ADHD about their condition and how to manage it more effectively. This paper describes the initial evaluation of this prototype. Nine parents and eleven children took part across nine online workshops and one phone call. The suitability and acceptability of the activity book prototype was explored, and areas of improvement identified. Sketch notes were taken for respondent validity and engagement purposes. Thematic analysis identified six themes: (1) Visual information; (2) Topic interest and engagement; (3) Importance of relatable content; (4) Importance of activity book interaction and age-appropriate content; (5) Positive aspects of ADHD and (6) The activity book as a communication aid. Improvement suggestions were also provided. Results indicate the activity book is suitable, acceptable and can act as a communication aid between young people and families. Future research may consider the development of versions of the activity book for adolescents with ADHD and young people with Autism Spectrum Disorder

Management of Poststroke Hyperglycemia : Results of the TEXAIS Randomized Clinical Trial

Hyperglycemia in acute ischemic stroke reduces the efficacy of stroke thrombolysis and thrombectomy, with worse clinical outcomes. Insulin-based therapies are difficult to implement and may cause hypoglycemia. We investigated whether exenatide, a GLP-1 (glucagon-like peptide-1) receptor agonist, would improve stroke outcomes, and control poststroke hyperglycemia with minimal hypoglycemia. Methods:The TEXAIS trial (Treatment With Exenatide in Acute Ischemic Stroke) was an international, multicenter, phase 2 prospective randomized clinical trial (PROBE [Prospective Randomized Open Blinded End-Point] design) enrolling adult patients with acute ischemic stroke ≤9 hours of stroke onset to receive exenatide (5 µg BID subcutaneous injection) or standard care for 5 days, or until hospital discharge (whichever sooner). The primary outcome (intention to treat) was the proportion of patients with ≥8-point improvement in National Institutes of Health Stroke Scale score (or National Institutes of Health Stroke Scale scores 0–1) at 7 days poststroke. Safety outcomes included death, episodes of hyperglycemia, hypoglycemia, and adverse event. Results:From April 2016 to June 2021, 350 patients were randomized (exenatide, n=177, standard care, n=173). Median age, 71 years (interquartile range, 62–79), median National Institutes of Health Stroke Scale score, 4 (interquartile range, 2–8). Planned recruitment (n=528) was stopped early due to COVID-19 disruptions and funding constraints. The primary outcome was achieved in 97 of 171 (56.7%) in the standard care group versus 104 of 170 (61.2%) in the exenatide group (adjusted odds ratio, 1.22 [95% CI, 0.79–1.88]; P=0.38). No differences in secondary outcomes were observed. The per-patient mean daily frequency of hyperglycemia was significantly less in the exenatide group across all quartiles. No episodes of hypoglycemia were recorded over the treatment period. Adverse events of mild nausea and vomiting occurred in 6 (3.5%) exenatide patients versus 0 (0%) standard care with no withdrawal. Conclusions:Treatment with exenatide did not reduce neurological impairment at 7 days in patients with acute ischemic stroke. Exenatide did significantly reduce the frequency of hyperglycemic events, without hypoglycemia, and was safe to use. Larger acute stroke trials using GLP-1 agonists such as exenatide should be considered. Registration:URL: www.australianclinicaltrials.gov.au; Unique identifier: ACTRN12617000409370. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03287076

Researching at the Community-University Borderlands: Using Public Science to Study Policing in the South Bronx

This article is a case study of the Morris Justice Project (MJP), a participatory action research (PAR) study in a South Bronx neighborhood of New York City (NYC) designed to understand residents\u27 experiences with and attitudes towards the New York Police Department (NYPD). An illustration of public science, the research was conducted in solidarity with an emerging police reform movement and in response to an ongoing and particularly aggressive set of policing policies that most heavily impacts poor communities and communities of color. The case study describes a set of ongoing participatory, research-action, sidewalk science strategies, developed in 42 square blocks of the South Bronx, designed to better understand and challenge the ongoing structural violence of the carceral state. Collaboratively written with members of the Morris Justice collective, we tell our story across three sections that outline the genesis of the project, describe our major commitments, and offers PAR and public science as a possible intervention in traditional university practice

Lipid-Based Nutrient Supplements During Pregnancy and Lactation Did Not Affect Human Milk Oligosaccharides and Bioactive Proteins in a Randomized Trial.

BACKGROUND: Human milk oligosaccharides (HMOs) and bioactive proteins are beneficial to infant health. Recent evidence suggests that maternal nutrition may affect the amount of HMOs and proteins in breast milk; however, the effect of nutrient supplementation on HMOs and bioactive proteins has not yet been well studied. OBJECTIVE: We aimed to determine whether lipid-based nutrient supplements (LNSs) affect milk bioactive protein and HMO concentrations at 6 mo postpartum in women in rural Malawi. These are secondary outcomes of a previously published randomized controlled trial. METHODS: Women were randomly assigned to consume either an iron and folic acid capsule (IFA) daily from ≤20 wk gestation until delivery, followed by placebo daily from delivery to 6 mo postpartum, or a multiple micronutrient (MMN) capsule or LNS daily from ≤20 wk gestation to 6 mo postpartum. Breast milk concentrations of total HMOs, sialylated HMOs, fucosylated HMOs, lactoferrin, lactalbumin, lysozymes, antitrypsin, immunoglobulin A, and osteopontin were analyzed at 6 mo postpartum (n = 647). Between-group differences in concentrations and in proportions of women classified as having low concentrations were tested. RESULTS: HMO and bioactive protein concentrations did not differ between groups (P > 0.10 for all comparisons). At 6 mo postpartum, the proportions of women with low HMOs or bioactive proteins were not different between groups except for osteopontin. A lower proportion of women in the IFA group had low osteopontin compared with the LNS group after adjusting for covariates (OR: 0.5; 95% CI: 0.3, 0.9; P = 0.016). CONCLUSION: The study findings do not support the hypothesis that supplementation with an LNS or MMN capsule during pregnancy and postpartum would increase HMO or bioactive milk proteins at 6 mo postpartum among Malawian women. This trial was registered at clinicaltrials.gov as NCT01239693

Genome-wide association and Mendelian randomisation analysis provide insights into the pathogenesis of heart failure

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. A small proportion of HF cases are attributable to monogenic cardiomyopathies and existing genome-wide association studies (GWAS) have yielded only limited insights, leaving the observed heritability of HF largely unexplained. We report results from a GWAS meta-analysis of HF comprising 47,309 cases and 930,014 controls. Twelve independent variants at 11 genomic loci are associated with HF, all of which demonstrate one or more associations with coronary artery disease (CAD), atrial fibrillation, or reduced left ventricular function, suggesting shared genetic aetiology. Functional analysis of non-CAD-associated loci implicate genes involved in cardiac development (MYOZ1, SYNPO2L), protein homoeostasis (BAG3), and cellular senescence (CDKN1A). Mendelian randomisation analysis supports causal roles for several HF risk factors, and demonstrates CAD-independent effects for atrial fibrillation, body mass index, and hypertension. These findings extend our knowledge of the pathways underlying HF and may inform new therapeutic strategies