An Aboriginal family and community healing program in metropolitan Adelaide: description and evaluation

This paper describes and evaluates the process, impacts and outcomes of an Aboriginal Family and Community Healing (AFCH) Program based in metropolitan Adelaide, South Australia. The evaluation used participatory action oriented methodology, mixed methods and multiple data sources. The AFCH comprised complex and dynamic activities for Aboriginal men, women and youth built around community engagement, and hosted by the regional primary health care Aboriginal outreach service. The AFCH Program was designed to develop effective responses to family violence that took into account the complexities within Aboriginal families and communities. The evaluation identified strengths of the program including: evidence-based design, holistic approach, clinical focus, committed staff, intersectoral linkages, peer support, mentoring, Aboriginal cultural focus, strategic partnerships and creative use of resources. Clients and workers were unanimous in their enthusiastic support for the program; their stories highlight beneficial impacts on Aboriginal clients, families and community. Other services may be able to adapt strategies from this AFCH to address the needs of their Aboriginal communities

The Glasgow consensus on the delineation between pesticide emission inventory and impact assessment for LCA

Purpose: Pesticides are applied to agricultural fields in order to optimise crop yield and their global use is substantial. Their consideration in Life cycle assessment (LCA) is currently affected by important inconsistencies between the emission inventory and impact assessment phases of LCA. A clear definition of the delineation between the product system model (life cycle inventory, technosphere) and the natural environment (life cycle impact assessment, ecosphere) is currently missing and could be established via consensus building. Methods: A workshop held on the 11 May 2013, in Glasgow, UK, back to back with the 23rd SETAC Europe meeting had the goal of establishing consensus and creating clear guidelines where the boundary between the emission inventory and the impact characterisation model should be set in all three spatial dimensions and time when considering application of substances to an open agricultural field or in greenhouses, and consequent emissions to the natural environment and their potential impacts. More than 30 specialists in agrifood LCI, LCIA, risk assessment, and ecotoxicology, representing industry, government, and academia from 15 countries and four continents met to discuss and reach consensus. The resulting guidelines target LCA practitioners, data (base) and characterisation method developers, and decision makers. Results and discussion: Although, the initial goal was to define recommendations concerning boundaries between technosphere and ecosphere, it became clear that these strongly depend on goal and scope of an LCA study. Instead, the focus was on defining a clear interface between LCI and LCIA, capable of supporting any goal and scope requirements while avoiding double counting or exclusion of important emission flows and their potential impacts. Consensus was reached accordingly on distinct sets of recommendations for LCI and LCIA respectively, recommending for example that buffer zones should be considered as part of the crop production system and the change in yield per ha be considered. While the spatial dimensions of the field were not fixed, the temporal boundary between dynamic LCI fate modelling and steady-state LCIA fate modelling needs to be defined. Conclusions and recommendations: For pesticides application, the inventory should report: pesticide identification, crop, mass applied of each active ingredient, application method or formulation type, presence of buffer zones (y/n), location/country, application time in days before harvest and crop growth stage during application, adherence with Good Agricultural Practice (GAP), and whether the field is considered part of the technosphere or the ecosphere. Additionally, emission fractions to defined environmental media on-field and off-field should be reported. For LCIA, the directly concerned impact categories were identified as well as a list of relevant fate and exposure processes. Next steps and future work were identified: 1) establishing default emission fractions to environmental media for integration into LCI databases, and 2) interaction among impact model developers to extend current methods with new elements/processes mentioned in the recommendations, including targeted technical workshops on “how to” model specific processes.JRC.H.8-Sustainability Assessmen

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The effect of an antenatal lifestyle intervention in overweight and obese women on circulating cardiometabolic and inflammatory biomarkers: secondary analyses from the LIMIT randomised trial

Background: Maternal overweight and obesity during pregnancy is associated with insulin resistance, hyperglycaemia, hyperlipidaemia and a low-grade state of chronic inflammation. The aim of this pre-specified analysis of secondary outcome measures was to evaluate the effect of providing antenatal dietary and lifestyle advice on cardiometabolic and inflammatory biomarkers. Methods: We conducted a multicentre trial in which pregnant women who were overweight or obese were randomised to receive either Lifestyle Advice or Standard Care. We report a range of pre-specified secondary maternal and newborn cardiometabolic and inflammatory biomarker outcomes. Maternal whole venous blood was collected at trial entry (mean 14 weeks gestation; non-fasting), at 28 weeks gestation (fasting), and at 36 weeks gestation (non-fasting). Cord blood was collected after birth and prior to the delivery of the placenta. A range of cardiometabolic and inflammatory markers were analysed (total cholesterol, triglycerides, non-esterified fatty acids, high-density lipoprotein cholesterol, insulin, glucose, leptin, adiponectin, C-reactive protein, granulocyte macrophage-colony stimulating factor, interferon gamma, TNF-α, and interleukins 1β, 2, 4, 5, 6, 8, and 10). Participants were analysed in the groups to which they were randomised, and were included in the analyses if they had a measure at any time point. Results: One or more biological specimens were available from 1951 women (989 Lifestyle Advice and 962 Standard Care), with cord blood from 1174 infants (596 Lifestyle Advice and 578 Standard Care). There were no statistically significant differences in mean cardiometabolic and inflammatory marker concentrations across pregnancy and in infant cord blood between treatment groups. Estimated treatment group differences were close to zero, with 95% confidence intervals spanning a range of differences that were short of clinical relevance. There was no evidence to suggest that the intervention effect was modified by maternal BMI category. Conclusions: Despite our findings, it will be worth considering potential relationships between cardiometabolic and inflammatory markers and clinical outcomes, including longer-term infant health and adiposity. Trial Registration Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426; Date Registered 09/03/2007). Electronic supplementary material The online version of this article (doi:10.1186/s12916-017-0790-z) contains supplementary material, which is available to authorized users

Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review

Malnutrition is associated with poor clinical outcomes among hospitalized patients. However, studies linking malnutrition with poor clinical outcomes in the intensive care unit (ICU) often have conflicting findings due in part to the inappropriate diagnosis of malnutrition. We primarily aimed to determine whether malnutrition diagnosed by validated nutrition assessment tools such as the Subjective Global Assessment (SGA) or Mini Nutritional Assessment (MNA) is independently associated with poorer clinical outcomes in the ICU and if the use of nutrition screening tools demonstrate a similar association. PubMed, CINAHL, Scopus, and Cochrane Library were systematically searched for eligible studies. Search terms included were synonyms of malnutrition, nutritional status, screening, assessment, and intensive care unit. Eligible studies were case-control or cohort studies that recruited adults in the ICU; conducted the SGA, MNA, or used nutrition screening tools before or within 48 hours of ICU admission; and reported the prevalence of malnutrition and relevant clinical outcomes including mortality, length of stay (LOS), and incidence of infection (IOI). Twenty of 1168 studies were eligible. The prevalence of malnutrition ranged from 38% to 78%. Malnutrition diagnosed by nutrition assessments was independently associated with increased ICU LOS, ICU readmission, IOI, and the risk of hospital mortality. The SGA clearly had better predictive validity than the MNA. The association between malnutrition risk determined by nutrition screening was less consistent. Malnutrition is independently associated with poorer clinical outcomes in the ICU. Compared with nutrition assessment tools, the predictive validity of nutrition screening tools were less consistent.Charles Chin Han Lew, Rosalie Yandell, Robert J. L. Fraser, Ai Ping Chua, Mary Foong Fong Chong and Michelle Mille