Shared Care Involving Cancer Specialists and Primary Care Providers - What Do Cancer Survivors Want?

This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving'. Copyright (2017) John Wiley & Sons, Inc. All rights reserved. This author accepted manuscript is made available following 12 month embargo from date of publication (May 2017) in accordance with the publisher’s archiving policyBackground Cancer survivors are living longer, prompting greater focus on managing cancer as a chronic condition. Shared care between primary care providers (PCPs) and cancer specialists, involving explicit partnership in how care is communicated, could ensure effective transitions between services. However, little is known about cancer patients' and survivors' preferences regarding shared care. Objective To explore Australian cancer survivors' views on shared care: what cancer survivors need from shared care; enablers and barriers to advancing shared care; and what successful shared care looks like. Setting and Participants Community forum held in Adelaide, Australia, in 2015 with 21 participants: 11 cancer survivors, 2 family caregivers, and 8 clinicians and researchers (members of PC4-Primary Care Collaborative Cancer Clinical Trials Group). Intervention Qualitative data from group discussion of the objectives. Results Participants stressed that successful shared care required patients being at the centre, ensuring accurate communication, ownership, and access to their medical records. PCPs were perceived to lack skills and confidence to lead complex cancer care. Patients expressed burden in being responsible for navigating information sharing and communication processes between health professionals and services. Effective shared care should include: shared electronic health records, key individuals as care coordinators; case conferences; shared decision making; preparing patients for self-management; building general practitioners' skills; and measuring outcomes. Discussion and Conclusions There was clear support for shared care but a lack of good examples to help guide it for this population. Recognizing cancer as a chronic condition requires a shift in how care is provided to these patients

The availability and geographic location of open-source food composition data used to estimate micronutrient intakes in sub-Saharan Africa: A scoping review

Background Estimates of dietary micronutrient intakes rely on food composition data. The nutrient composition of foods varies spatially with potentially large effects on dietary micronutrient intakes. This review assessed the availability and geographic origin of five minerals (calcium, iron, iodine, selenium and zinc) in publicly available food composition tables/databases (FCTs) for use in sub-Saharan Africa (SSA). Methods A scoping review was conducted following PRISMA guidelines, in which four databases (MEDLINE, Embase, Global Health and Africa Wide Information) and four online resources were searched to identify published FCTs for use in SSA. Metadata were reviewed to identify the geographic origin of composition values for selected foods. Results Nineteen publicly available FCTs were identified, with the highest geographic coverage in Eastern Africa (45% of countries) and lowest coverage in Central Africa (12% of countries). Iodine and selenium were reported in four and six FCTs, respectively, while iron and calcium were included in ≥ 18 FCTs. More than 60% of nutrient values were borrowed from other FCTs. The geographic origin of 22% of mineral values were documented. Conclusions Limited local food composition analytical data is available, for estimating mineral intakes of SSA populations, with poor documentation of the data sources and the geographic origins of samples. New data structures and improved metadata are required to capture and report geographic information in publicly available FCTs, and to accommodate a new generation of spatially-resolved food composition data

Dietary selenium intake among Ethiopian children in areas known for selenium spatial variability

Introduction: There is spatial variability of selenium (Se) in soil and crops in Ethiopia. We assessed the Se content of food items, breast milk, and urine among infants in Ethiopia from two areas with contrasting Se concentrations in soils. Methods: Dietary Se intakes among children (6–23 months) were evaluated using a weighed food record on two non-consecutive days. Also, spot urine samples from children and breast milk samples from their mothers were collected to determine Se concentration. Selenium concentrations in the samples were analyzed using an inductively coupled plasma mass spectrometer (ICP-MS). Results: Injera (prepared from teff and mixtures of other cereals) with a legume-based stew were the most frequently consumed foods by the children in both areas, followed by pasta. Overall, the Se concentration (mean ± SD) of food items, breast milk (12.2 ± 3.9 μg/L vs. 3.39 ± 1.5 μg/L), and urine samples (22.5 ± 11.5 μg/L vs. 3.0 ± 1.9 μg/L) from East Amhara were significantly higher than the corresponding samples from West Amhara (p < 0.001). The total Se intakes by the study children from East Amhara and West Amhara were 30.2 [IQ 25%, 14.2; IQ 75%, 54.1] and 7.4 [IQR 25%, 4.2; IQ 75%, 10.6] μg day–1, respectively; 31.5% of children from East Amhara and 92% of children from West Amhara were at risk of inadequate Se intakes. Urinary Se excretion accounted for 53 and 39% of daily dietary Se intake in East Amhara and West Amhara, respectively. Dietary Se intake was positively correlated with urinary Se excretion in East Amhara (r = 0.56; p < 0.001) but not among samples from West Amhara (r = 0.16; p ≥ 0.05), suggesting greater physiological Se conservation in a state of deficiency. Conclusion: There is spatial variability of Se in foods, breast milk, and urine in Ethiopia, suggesting the need for implementation of targeted agronomic interventions that enhance Se concentrations in the edible portion of plant foods

Stories of God\u27s Love: Preschool Program (Ages 3-4)

Stories of God’s Love is a Bible-based program prepared by a team of respected preschool specialists from the University of Dayton and is written following the directives developed by the U.S. Conference of Catholic Bishops. The leaflet style format proclaims age appropriate Bible stories as well as contemporary stories which connect the scripture story to an everyday life experience of a preschool child. Seasonal leaflets introduce and explore holy days, holidays and the seasons of the year. A music component, poster set and program director manual completes the program. Multi-day and one-day guides are available

The effect of case management on childhood pneumonia mortality in developing countries

Background With the aim of populating the Lives Saved Tool (LiST) with parameters of effectiveness of existing interventions, we conducted a systematic review of the literature assessing the effect of pneumonia case management on mortality from childhood pneumonia

Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria

<p>Abstract</p> <p>Background</p> <p>Zinc deficiency is commonly prevalent in children in developing countries and plays a role in decreased immunity and increased risk of infection. Preventive zinc supplementation in healthy children can reduce mortality due to common causes like diarrhea, pneumonia and malaria. The main objective was to determine all-cause mortality and cause-specific mortality and morbidity in children under five in developing countries for preventive zinc supplementation.</p> <p>Data sources/ review methods</p> <p>A literature search was carried out on PubMed, the Cochrane Library and the WHO regional databases to identify RCTs on zinc supplementation for greater than 3 months in children less than 5 years of age in developing countries and its effect on mortality was analyzed.</p> <p>Results</p> <p>The effect of preventive zinc supplementation on mortality was given in eight trials, while cause specific mortality data was given in five of these eight trials. Zinc supplementation alone was associated with a statistically insignificant 9% (RR = 0.91; 95% CI: 0.82, 1.01) reduction in all cause mortality in the intervention group as compared to controls using a random effect model. The impact on diarrhea-specific mortality of zinc alone was a non-significant 18% reduction (RR = 0.82; 95% CI: 0.64, 1.05) and 15% for pneumonia-specific mortality (RR = 0.85; 95% CI: 0.65, 1.11). The incidence of diarrhea showed a 13% reduction with preventive zinc supplementation (RR = 0.87; 95% CI: 0.81, 0.94) and a 19% reduction in pneumonia morbidity (RR = 0.81; 95% CI: 0.73, 0.90). Keeping in mind the direction of effect of zinc supplementation in reducing diarrhea and pneumonia related morbidity and mortality; we considered all the outcomes for selection of effectiveness estimate for inclusion in the LiST model. After application of the CHERG rules with consideration to quality of evidence and rule # 6, we used the most conservative estimates as a surrogate for mortality. We, therefore, conclude that zinc supplementation in children is associated with a reduction in diarrhea mortality of 13% and pneumonia mortality of 15% for inclusion in the LiST tool. Preventive zinc supplementation had no effect on malaria specific mortality (RR = 0.90; 95% CI: 0.77, 1.06) or incidence of malaria (RR=0.92; 95 % CI 0.82-1.04)</p> <p>Conclusion</p> <p>Zinc supplementation results in reductions in diarrhea and pneumonia mortality.</p

Food-based dietary guidelines for optimizing calcium intakes for reproductive-aged women in Ethiopia using local foods

© 2024 The Author(s). Annals of the New York Academy of Sciences published by Wiley Periodicals LLC on behalf of The New York Academy of Sciences.Increasing dietary calcium intakes of Ethiopian women of reproductive age (WRA) is a public health priority for reducing pre-eclampsia in pregnancy. Using linear programming, we determined whether locally available foods consumed by WRA in nine regions (urban and rural) and two administrative cities of Ethiopia could provide 1000 mg/day of dietary calcium, and we identified food-based recommendations (FBRs) to improve dietary calcium adequacy in each region. Results showed that diets providing 1000 mg/day of calcium were feasible in eight regions (40%) of the target populations examined. It would, however, require marked changes for most populations (90%), increasing the number of servings per week of several food groups to levels close to those of high consumers in each population. The selected calcium-specific FBRs integrate well into the 2022 Ethiopian Dietary Guidelines, requiring additional messages to consume green leafy vegetables, milk, root crops, or teff (Eragrostis tef) or to consume a higher number of servings of vegetables than currently recommended, depending on the population. In conclusion, these analyses show that a food-based approach can be used to achieve dietary calcium adequacy among WRA in 40% of the populations examined. For the other populations, food-based interventions alone may be inadequate and other interventions are likely needed.publishersversionepub_ahead_of_prin

A qualitative study on resource barriers facing scaled container-based sanitation service chains

Container-based sanitation (CBS) is an increasingly recognised form of off-grid sanitation provision appropriate for impoverished urban environments. To ensure a safely managed and sustainable service, a managing organisation must implement a service chain that performs robustly and cost-effectively, even with an expanding customer base. These ‘CBS operators’ adopt varying approaches to achieve this objective. Following research including interviews with representatives from six current CBS operators, this paper presents a generalised diagrammatic model of a CBS service chain and discusses the three broad thematic challenges currently faced by these organisations. Supplying cover material is a universal problem with hidden challenges when taking advantage of freely available resources. There is no universally applicable approach for the efficient collection of faecal waste despite the high labour costs of waste collection. The best strategy depends on the CBS operator's overall expansion strategy and the location of fixed features within the served community. Although CBS is technically well-suited to being turned into new products within the circular economy, in practice, this requires a diverse range of skills from CBS operators and is hampered by slow growth in other organic waste recovery services and unhelpful regulation