A survey of children's beliefs, expectations and preferences about the consequences of disclosing intrafamilial abuse

Bibliography: pages [50-58].The present study investigates the attitudes and beliefs of children about potentially disclosing intrafamilial abuse. The sample was drawn from the peri-urban settlement of Mdantsane and the rural villages of Nowawe. A pilot study involving 28 children in qualitative interviews was conducted. Content analysis of these answers were used to compile a questionnaire which was administered to 489 children by locally trained fieldworkers. The questionnaire contained questions pertaining to demographics, health, social support, and closed-ended Likert scales for the measurement of beliefs and intentions about disclosing intrafamilial abuse. Two open-ended questions were included to investigate children's preferences about the outcome of disclosing abuse. Children's experience of safety in and out of home, as well as their preferences about who to disclose to, were also measured. Questions pertaining to family and to abuse were asked in a way that allowed individual children to define the parameters of these concepts rather than assuming definitions for them. The results were analysed descriptively for the total sample. Where the data was examined for relationships and differences according to age, sex and where the children lived, Chi-square and ANOV A tests were conducted. In the case of significant findings, post-hoc analysis was carried out using residual analysis and the Newman-Keuls procedure, respectively. The findings revealed that 88% of the sample intended to report intrafamilial abuse if this happened to them, but only half expected to be believed. Strong variations in beliefs and intentions were found to exist on the basis of where children lived, with children from the poorest and oldest settlement in Mdantsane consistently emerging as less trusting of their environment and therefore less able to seek help, as compared to children living in the informal settlement or the affluent neighbourhood. Older children were found to differ from younger ones on the basis of being less confident that they would be believed if they were to disclose. The main difference between male and female children involved variations in their beliefs about whether there would be consequences for the abuser and themselves if they reported abuse. Overall, the degree of duality and contradictions as regards how children wanted to respond to intrafamilial abuse, and what they believed to be the consequences of disclosing this, point to the importance of developing services that can adapt to differences between communities and groupings within these communities rather than responding in a homogenous manner to all incidents of child abuse. Limitations associated with survey methodology and interviewer bias are acknowledged

Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring.

BACKGROUND: Monitoring financial protection against catastrophic health expenditures is important to understand how health financing arrangements in a country protect its population against high costs associated with accessing health services. While catastrophic health expenditures are generally defined to be when household expenditures for health exceed a given threshold of household resources, there is no gold standard with several methods applied to define the threshold and household resources. These different approaches to constructing the indicator might give different pictures of a country's progress towards financial protection. In order for monitoring to effectively provide policy insight, it is critical to understand the sensitivity of measurement to these choices. METHODS: This paper examines the impact of varying two methodological choices by analysing household expenditure data from a sample of 47 countries. We assess sensitivity of cross-country comparisons to a range of thresholds by testing for restricted dominance. We further assess sensitivity of comparisons to different methods for defining household resources (i.e. total expenditure, non-food expenditure and non-subsistence expenditure) by conducting correlation tests of country rankings. RESULTS: We found country rankings are robust to the choice of threshold in a tenth to a quarter of comparisons within the 5-85% threshold range and this increases to half of comparisons if the threshold is restricted to 5-40%, following those commonly used in the literature. Furthermore, correlations of country rankings using different methods to define household resources were moderate to high; thus, this choice makes less difference from a measurement perspective than from an ethical perspective as different definitions of available household resources reflect varying concerns for equity. CONCLUSIONS: Interpreting comparisons from global monitoring based on a single threshold should be done with caution as these may not provide reliable insight into relative country progress. We therefore recommend financial protection against catastrophic health expenditures be measured across a range of thresholds using a catastrophic incidence curve as shown in this paper. We further recommend evaluating financial protection in relation to a country's health financing system arrangements in order to better understand the extent of protection and better inform future policy changes

Second Record and DNA Barcode of the Ant Tyrannomyrmex rex Fernández (Hymenoptera: Formicidae: Myrmicinae)

Tyrannomyrmex is a rarely collected ant genus from Old World tropical forests comprising only three described species, all of them known from a single worker. Here we report the discovery of a second worker of Tyrannomyrmex rex from a selectively logged primary forest of Singapore, increasing the known distribution range of the species to nearly 250 km South-East. We also provide a DNA barcode for the species and a partial sequence of the wingless gene. Although insufficient evidence prevents us to draw any firm conclusion, the genus seems to be restricted to pristine or relatively undisturbed forests and, as a result, could be highly sensitive to habitat degradation

Lipidomics reveals seasonal shifts in a large-bodied hibernator, the brown bear

publishedVersio

[Study Protocol] Palliative long-term abdominal drains versus repeated drainage in individuals with untreatable ascites due to advanced cirrhosis: study protocol for a feasibility randomised controlled trial

Background: UK deaths due to chronic liver diseases such as cirrhosis have quadrupled over the last 40 years, making this condition now the third most common cause of premature death. Most patients with advanced cirrhosis (end–stage liver disease, [ESLD]) develop ascites. This is often managed with diuretics, but if refractory then the fluid is drained from the peritoneal cavity every 10-14 days by large volume paracentesis (LVP), a procedure requiring hospital admissions. As the life expectancy of patients with ESLD and refractory ascites (if ineligible for liver transplantation) is on average ≤ 6 months, frequent hospital visits are inappropriate from a palliative perspective. One alternative is long-term abdominal drains (LTAD), used successfully in patients whose ascites is due to malignancy. Although inserted in hospital, these drains allow ascites management outside of a hospital setting. LTAD have not been formally evaluated in patients with refractory ascites due to ESLD. Methods: Due to uncertainty about appropriate outcome measures and whether patients with ESLD would wish or be able to participate in a study, a feasibility randomised controlled trial (RCT) was designed. Patients were consulted on trial design. We plan to recruit 48 patients with refractory ascites and randomise them (1:1) to either a) LTAD or b) current standard of care (LVP) for 12 weeks. Outcomes of interest include acceptability of LTAD to patients, carers and healthcare professionals as well as recruitment and retention rates. Palliative care Outcome Scale (IPOS), the Short Form Liver Disease Quality of Life (SF-LDQOL), the EuroQol (EQ-5D) and carer (Zarit Burden Interview [ZBI-12]) reported outcomes will also be assessed. Preliminary data on cost effectiveness will be collected and patients and healthcare professionals will be interviewed about their experience of the trial with a view to identifying barriers to recruitment. Discussion: LTAD could potentially improve end-of-life care in patients with refractory ascites due to ESLD by improving symptom control, reducing hospital visits and enabling some self-management. Our trial is designed to see if such patients can be recruited, as well as informing the design of a subsequent definitive trial. Trial registration: ISRCTN30697116, date assigned: 07/10/201

Critical Reflections on Methodological Challenge in Arts and Dementia Evaluation and Research

Methodological rigour, or its absence, is often a focus of concern for the emerging field of evaluation and research around arts and dementia. However, this paper suggests that critical attention should also be paid to the way in which individual perceptions, hidden assumptions and underlying social and political structures influence methodological work in the field. Such attention will be particularly important for addressing methodological challenges relating to contextual variability, ethics, value judgement, and signification identified through a literature review on this topic. Understanding how, where and when evaluators and researchers experience such challenges may help to identify fruitful approaches for future evaluation. This paper is based upon a presentation on the subject given at the First International Research Conference on the Arts and Dementia: Theory, Methodology and Evidence on 9 March 2017

Association between vision impairment and mortality: protocol for a systematic review and meta-analysis.

Funder: Christian Blind MissionFunder: Queen Elizabeth Diamond Jubilee TrustFunder: Seva FoundationFunder: NIHR Moorfields Biomedical Research CentreFunder: British Council for the Prevention of BlindnessFunder: Sightsavers International; FundRef: http://dx.doi.org/10.13039/501100004324Funder: Fred Hollows Foundation; FundRef: http://dx.doi.org/10.13039/100014445INTRODUCTION: Due to growth and ageing of the world's population, the number of individuals worldwide with vision impairment (VI) and blindness is projected to increase rapidly over the coming decades. VI and blindness are an important cause of years lived with disability. However, the association of VI and blindness with mortality, including the risk of bias in published studies and certainty of the evidence, has not been adequately studied in an up-to-date systematic review and meta-analysis. METHODS AND ANALYSIS: The planned systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases, including MEDLINE Ovid, Embase Ovid and Global Health, will be searched for relevant studies. Two reviewers will then screen studies and review full texts to identify studies for inclusion. Data extraction will be performed, and for included studies, the risk of bias and certainty of the evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. The prognostic factor in this study is visual function, which must have been measured using a standard objective ophthalmic clinical or research instrument. We will use standard criteria from WHO to categorise VI and blindness. All-cause mortality may be assessed by any method one or more years after baseline assessment of vision. Results from included studies will be meta-analysed according to relevant sections of the Meta-analysis Of Observational Studies in Epidemiology checklist. ETHICS AND DISSEMINATION: This review will only include published data; therefore, ethics approval will not be sought. The findings of this review and meta-analysis will be published in an open-access, peer-reviewed journal and will be included in the ongoing Lancet Global Health Commission on Global Eye Health