Mental health care and resistance to fascism

Mental health nurses have a critical stake in resisting the right-wing ideology of British fascism. Particularly concerning is the contemporary effort of the British National Party (BNP) to gain credibility and electoral support by the strategic re-packaging of a racist and divisive political manifesto. Evidence that some public sector workers are affiliated with the BNP has relevance for nursing at a series of levels, not least the incompatibility of party membership with a requirement of the Professional Code to avoid discrimination. Progressive advances, though, need to account for deep rooted institutionalized racism in the discourse and practice of healthcare services. The anomalous treatment of black people within mental health services, alongside racial abuse experienced by ethnic minority staff, is discussed in relation to the concept of race as a powerful social category and construction. The murder of the mentally ill and learning disabled in Nazi Germany, as an adjunct of racial genocide, is presented as an extreme example where professional ethics was undermined by dominant political ideology. Finally, the complicity of medical and nursing staff in the state sanctioned, bureaucratic, killing that characterized the Holocaust is revisited in the context of ethical repositioning for contemporary practice and praxis

“God is Hidden in the Earthly Kingdom:” The Lutheran Two-Kingdoms Theory as Foundation of Scandavanian Secularity

Martin Luther’s signature “two kingdoms” teaching of the sixteenth century was an early and innovative theory of secularization that lies at the heart of historical Scandinavian culture. Defying the organic medieval models of Western Christendom, Luther separated the heavenly and earthly kingdoms, the saint and the sinner, faith and reason, church and the state, Gospel and the Law, as well as the spiritual and secular uses of law, government and authority. Though God is separated from day-to-day life, Luther wrote, God is still hidden in the earthly kingdom” and can be seen through various “masks,” “mists,” and “mimes.” Though the visible church is separated from the state and other institutions, religion remains pervasive in the common callings of every person to be God’s prophet, priest and king in every vocation and location of life. Luther’s two kingdoms theory is a complicated and controversial part of this thinking, but it is worth re-exploring today as pluralistic Scandinavia faces strong new pressures of both sacralization and secularization and seeks to discern anew “the hidden sacraliity of the secular.

Evaluation of existing control measures in reducing health and safety risks of engineered nanomaterials

While the risk management of engineered nanomaterials (ENMs) receives significant attention, there is still a limited understanding of how to select optimal risk management measures (RMMs) for controlling and mitigating the risks associated with exposure to ENMs. Clearly, there exists a need to expand current risk management practices to ensure safe production, handling and use of ENMs. Moreover, the performance of the existing RMMs should be re-evaluated for ENMs since control options that are proven to be effective for preventing or limiting risks associated with traditional particles might give unsatisfactory results in the case of nano-scale particles. This paper has brought together the evidence on the adequacy of traditional controls to minimize potential health and environmental risks resulting from exposure to ENMs. The aim here is to advance our understanding of the risk management approaches relevant for ENMs, and ultimately to support the selection of the most suitable RMMs when handling ENMs. To that end, evaluative evidence collected from the review of relevant literature and survey of nanotechnology institutions are combined and summarised to understand the level of protection offered by each control measure, as well as the relative costs of their implementation. The findings suggest that most relevant risk control options are based on isolating people from hazard through engineering measures (e.g. ventilation and chemical fume hoods) or personal protective equipment (PPE), rather than eliminating hazard at source (e.g. substitution). Although control measures related to the modification of ENMs have high efficiency in the occupational risk control hierarchy, they are not widely employed since there is currently a high degree of uncertainty regarding the impact of manipulating nano-characteristics on the performance of final product. Lastly, despite its low cost, PPE is the least effective category in the occupational risk control hierarchy and should not be used on its own when significant risk reduction is required. Clearly, further quantitative data is needed to fully assess the feasibility and cost-effectiveness of risk control options to prevent risks from exposure to ENMs. When there is little information on the efficiency of control measures specific to ENMs, the default efficiencies can be used for initial assessment purposes although it should not be considered exhaustive

Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta‐analysis

Background Prehabilitation has emerged as a strategy to prepare patients for elective abdominal cancer surgery with documented improvements in postoperative outcomes. The aim of this study was to assess the evidence for prehabilitation interventions of relevance to the older adult. Methods Systematic searches were conducted using MEDLINE, Web of Science, Scopus, CINAHL and PsychINFO. Studies of preoperative intervention (prehabilitation) in patients undergoing abdominal cancer surgery reporting postoperative outcomes were included. Age limits were not set as preliminary searches revealed this would be too restrictive. Articles were screened and selected based on PRISMA guidelines, and assessment of bias was performed. Qualitative, quantitative and meta‐analyses of data were conducted as appropriate. Results Thirty‐three studies (3962 patients) were included. Interventions included exercise, nutrition, psychological input, comprehensive geriatric assessment and optimization, smoking cessation and multimodal (two or more interventions). Nine studies purposely selected high‐risk, frail or older patients. Thirty studies were at moderate or high risk of bias. Ten studies individually reported benefits in complication rates, with meta‐analyses for overall complications demonstrating significant benefit: multimodal (risk difference −0·1 (95 per cent c.i. −0·18 to −0·02); P = 0·01, I2 = 18 per cent) and nutrition (risk difference −0·18 (−0·26 to −0·10); P < 0·001, I2 = 0 per cent). Seven studies reported reductions in length of hospital stay, with no differences on meta‐analysis. Conclusion The conclusions of this review are limited by the quality of the included studies, and the heterogeneity of interventions and outcome measures reported. Exercise, nutritional and multimodal prehabilitation may reduce morbidity after abdominal surgery, but data specific to older patients are sparse

Indoor Air Quality (IAQ) in Naturally-ventilated Primary Schools in the UK:Occupant-Related Factors

Indoor Air Quality (IAQ) is affected by Context, Occupant and Building (COB) related factors. This paper evaluates IAQ as a function of occupant-related factors including occupants' Adaptive Behaviours (ABs), occupancy patterns, occupant's CO2 generation rates and occupancy density. This study observed occupant-related factors of 805 children in 29 naturally-ventilated (NV) classrooms in UK primary schools during Non-Heating and Heating seasons. Occupant-related factors affecting IAQ include occupants' adaptive behaviours, occupancy patterns, occupants' CO2 generation rate and occupancy densities. Results of this study suggest that a classroom with high potentials for natural ventilation does not necessarily provide adequate IAQ, however, occupants’ good practice of ABs is also required. Average occupancy densities to have CO2 levels of 1000 ± 50 ppm are suggested to be 2.3 ± 0.05m2/p and 7.6 ± 0.25 m3/p. These values correspond to the classroom area of 62.1 ± 1.35 m2 and volume of 205.2 ± 6.75 m3 with a height of 3.3 m. Mean CO2 level is maintained below 900 ppm when all occupant-related factors are in the favour of IAQ, however, it exceeds 1300 ppm when none of the occupant-related factors are in favour of IAQ. It is shown that 17% of CO2 variations are explained by open area (m2), 14% by occupants' generation rates (cm3/s) and 11% by occupancy density (m3/p). IAQ is mostly affected by occupants’ adaptive behaviours than other occupant-related factors in naturally-ventilated classrooms

A Review of the Adverse Effects of Peripheral Alpha-1 Antagonists in Hypertension Therapy

BACKGROUND: Doxazosin and its role as an antihypertensive agent have come under recent scrutiny as a result of the early termination of that treatment arm in ALLHAT. It is unclear why the cardiovascular (CV) event rate in this randomized, controlled trial (RCT), especially heart failure, is higher in those treated with a doxazosin-based regimen than with a chlorthalidone based-regimen. There has been little work in the past to summarize information on peripheral alpha-1 antagonists that may be helpful in evaluating the results of this randomized controlled trial. METHODS: Using Medline and the Cochrane databases, we performed a comprehensive review of the literature on the use of peripheral alpha-1 antagonists as antihypertensive agents, focusing on available information that could explain the excess cardiovascular events observed in the Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial (ALLHAT). RESULTS: Minimal data were available concerning the effects of peripheral alpha-1 antagonists on CV endpoints. A multitude of short-term studies-ranging from small observational studies to short-term moderate-sized RCTs – focused on safety, efficacy, and tolerability, and some studies investigated the physiologic effects of these agents. These previously reported studies reveal associations with weight gain, fluid retention, and neurohormonal changes among various populations of those treated with peripheral alpha-1 antagonists. CONCLUSION: These findings suggest several possible mechanisms by which doxazosin may be inferior to low-dose diuretics as antihypertensive therapy for the prevention of heart failure

Adolescent and adult first time mothers' health seeking practices during pregnancy and early motherhood in Wakiso district, central Uganda

<p>Abstract</p> <p>Background</p> <p>Maternal health services have a potentially critical role in the improvement of reproductive health. In order to get a better understanding of adolescent mothers'needs we compared health seeking practices of first time adolescent and adult mothers during pregnancy and early motherhood in Wakiso district, Uganda.</p> <p>Methods</p> <p>This was a cross-sectional study conducted between May and August, 2007 in Wakiso district. A total of 762 women (442 adolescents and 320 adult) were interviewed using a structured questionnaire. We calculated odds ratios with their 95% CI for antenatal and postnatal health care seeking, stigmatisation and violence experienced from parents comparing adolescents to adult first time mothers. STATA V.8 was used for data analysis.</p> <p>Results</p> <p>Adolescent mothers were significantly more disadvantaged in terms of health care seeking for reproductive health services and faced more challenges during pregnancy and early motherhood compared to adult mothers. Adolescent mothers were more likely to have dropped out of school due to pregnancy (OR = 3.61, 95% CI: 2.40–5.44), less likely to earn a salary (OR = 0.43, 95%CI: 0.24–0.76), and more likely to attend antenatal care visits less than four times compared to adult mothers (OR = 1.52, 95%CI: 1.12–2.07). Adolescents were also more likely to experience violence from parents (OR = 2.07, 95%CI: 1.39–3.08) and to be stigmatized by the community (CI = 1.58, 95%CI: 1.09–2.59). In early motherhood, adolescent mothers were less likely to seek for second and third vaccine doses for their infants [Polio2 (OR = 0.73, 95% CI: 0.55–0.98), Polio3 (OR = 0.70: 95% CI: 0.51–0.95), DPT2 (OR = 0.71, 95% CI: 0.53–0.96), DPT3 (OR = 0.68, 95% CI: 0.50–0.92)] compared to adult mothers. These results are compelling and call for urgent adolescent focused interventions.</p> <p>Conclusion</p> <p>Adolescents showed poorer health care seeking behaviour for themselves and their children, and experienced increased community stigmatization and violence, suggesting bigger challenges to the adolescent mothers in terms of social support. Adolescent friendly interventions such as pregnancy groups targeting to empower pregnant adolescents providing information on pregnancy, delivery and early childhood care need to be introduced and implemented.</p

Ventilation rates in naturally ventilated primary schools in the UK; Contextual, Occupant and Building-related (COB) factors

Indoor Air Quality (IAQ) in classrooms is assessed by CO2 levels and Ventilation Rates (VRs). Factors affecting VRs fall into Contextual, Occupant and Building (COB) related factors. This study investigates how VRs are affected by COB factors in 29 naturally-ventilated classrooms in the UK during Non-Heating and Heating seasons. Building-related factors classify classrooms with high or low potentials for natural ventilation, with 45% of classrooms having high potentials. Contextual factors including season, operative temperature (Top), outdoor temperature (Tout), ‘Top-Tout’ and air density can limit or increase VRs. Occupant-related factors classify occupant's good or poor practice of environmental adaptive behaviours. ‘Open area’ as a reflection of all COB factors is strongly correlated with ventilation rates. Results show that 12% and 19% of variations in ventilation rates are explained by open areas during non-heating and heating seasons, respectively. Findings highlight that to have VR of 8 ± 1.28 l/s.p during non-heating seasons and VR of 8 ± 1.07 l/s.p during heating seasons, average open areas of 3.8 m2 and 2 m2 are required, respectively. This difference can mostly be explained by temperature difference between inside and outside. Results show COB factors need to be considered holistically to maintain adequate VRs. Classrooms in which all COB factors are met provide average VR of 11 l/s.p and classrooms in which none of COB factors are met provide average VR is 3.1 l/s.p. This study highlights that 40% of classrooms according to EN 13779 and 80% of classrooms according to ASHRAE Standard fail to provide adequate VRs