Research evidence to inform strengths-based policy and practice: mapping the coping strategies of young women in Mozambique

Unintended pregnancy amongst young women in Mozambique is associated with many ‘problems’ and ‘poor outcomes’; yet little is known about how young women, their family and communities actually respond to these problems. Qualitative research on the coping strategies used by young mothers under 20 years of age in response to conflictual relationships, poor material provision, poor health and poor educational access in Mozambique is presented. Data was constructed through 21 semi-structured narrative interviews with young mothers (16-19 years old) from two regions (urban/south and rural/north) on their experience of coping with unintended pregnancy. Thematic data analysis to identify coping strategies was completed using Nvivo 7. The majority of strategies identified were ‘relational’ in nature highlighting the importance of developing interventions which strengthen naturally occurring strategies used by women, their families and communities. The findings are used to illustrate the role of strength-based research in developing policy and practice, particularly in relation to community development and groups considered unable to ‘cope’ or ‘get on’. It is also important to ensure strengths-based approaches are used to tackle structural inequalities and strengthen organisational resources, despite this being a strong critique levied at strength-based interventions

Unaccompanied and separated Syrian refugee children: case study of a new feature for social work practice in Jordan

While Jordan has hosted many refugees within its borders over the past 70 years, the recent influx of Syrian refugees has significantly increased pressure on an already fragile economic and social landscape. The Jordan Response Plan to Syrian Refugees advocates for emergency response that meets the basic needs of refugees alongside long-term capacity building of Jordanian services and infrastructure; with the Protection Working Group (an inter-agency working group with sub groups on child protection, gender-based violence and mental health) specifically advocating for more social workers. While the role of social workers in working with refugees is relatively well established in destination countries (such as the United States, Canada, Australia, parts of Europe), it is less well established in neighbouring and transition countries – countries which are the ‘first’ responders and host the bulk of refugees. By describing a case study on the role of social workers in a foster care programme for unaccompanied and separated Syrian refugee children in Jordan, we establish the contribution that social workers can make to the multi-disciplinary team to improve the short and long-term well-being of refugees. The paper concludes with a number of policy recommendations

Risky behaviour: a new framework for understanding why young people take risks

Theories of youth risk taking range from the realist to the sociocultural. Much of this theorising, particularly in the field of epidemiology, has been strongly influenced by the Health Belief Framework. More recently, attention has shifted to understanding how young people perceive risk and what makes some of them resilient to risk taking. In this article we develop a framework that brings together diverse theoretical perspectives on youth risk taking. We draw on lessons from across the social science disciplines to inform a conceptual framework incorporating the broad context and internal processes of young people’s decisions to take risks. Our Youth Risk Interpretation Framework (Y-RIF) has been developed from insights gained during an ethnographic study conducted in South Africa (REMOVED FOR BLIND REVIEW). We argue that our framework is useful, as it offers new ways of understanding why some young people take risks while others are more cautious. It could be used to inform youth behaviour surveillance research and interventions. However, it will need to be rigorously tested

Resurrecting the interval of need concept to improve dialogue between researchers, policymakers, and social care practitioners

Academics, social care practitioners, and policymakers speak different languages. If academic research is to have an impact on society, it must be understandable and convincing to the end users. We argue that the conceptualisation of social care ‘need’ is different among these stakeholders, leading to poor communication between them. Academics should use concepts that have more meaning to practitioners. We propose resurrecting a little-used concept from the 1970s, ‘interval of need’, to help to bridge this gap. The interval of need concept identifies how often people require help, supplementing the usual data about types of tasks where assistance is needed. The history of the concept is described, followed by a test of its usefulness for today’s researchers by applying it to data from the English Longitudinal Study of Ageing. An updated version of interval of need is proposed. Validation checks were conducted against mortality data, and through conceptual validation from a social work practitioner. The nature of the dataset limited comparability with previous studies. However, we conclude that the interval of need concept has promising scope to enhance communication of research findings, potentially leading to improved outcomes for service users. This paper strives to mark a turning point in the language and analysis of social care, ensuring that academic investigation in this field is convincing and clear to practitioners and policymakers

Child protection with Muslim communities: considerations for non-Muslim-based orthodoxies/paradigms in child welfare and social work

The care and protection of children are a concern that crosses ethnic, religious and national boundaries. How communities act on these concerns are informed by cultural and religious understandings of childhood and protection. Islam has specific teachings that relate to the care and guardianship of children and are interpreted in diverse ways across the Muslim world. Islamic teachings on child-care mostly overlap with Western understandings of child protection, but there can be some contested positions. This creates complexities for social workers intervening in Muslim communities where the basis of their intervention is primarily informed by a non-Muslim paradigm or occurs in secular legal contexts. The purpose of this article is to address at a broad level the issue of how overarching concepts of child protection and Islam influence social work practice with Muslim communities. It addresses a gap in practical applications of the synergy of  Islamic thinking with core social work practice in the field of child protection. For effective practice, it is argued that social work practitioners need to consider common ground in Islamic thinking on child protection rather than rely on Western frameworks. This requires further research to build evidence-based practice with Muslim families

Enhancement of clonogenicity of human multiple myeloma by dendritic cells

Infiltration by dendritic cells (DCs) is a common feature of most human tumors. Prior studies evaluating the interaction of DCs with tumors have focused largely on their immunologic properties (for review see Banchereau, J., and R.M. Steinman. 1998. Nature. 392:245–252). In this study, we show that the clonogenicity of several human tumor cell lines and primary tumor cells from myeloma patients is enhanced by their interactions with DCs. Myeloma cells cultured in the presence of DCs have an altered phenotype with an increased proportion of cells lacking terminal plasma cell differentiation marker CD138. DC–tumor interaction also leads to the up-regulation of B cell lymphoma 6 expression in myeloma cells. Effects of DCs on myeloma cells are inhibited by blockade of the receptor activator of NF-kB (RANK)–RANK ligand and B cell–activating factor–APRIL (a proliferation-inducing ligand)-mediated interactions. Together, these data suggest that tumor–DC interactions may directly impact the biology of human tumors, particularly multiple myeloma, and may be a target for therapeutic intervention

Sustained expansion of NKT cells and antigen-specific T cells after injection of α-galactosyl-ceramide loaded mature dendritic cells in cancer patients

Natural killer T (NKT) cells are distinct glycolipid reactive innate lymphocytes that are implicated in the resistance to pathogens and tumors. Earlier attempts to mobilize NKT cells, specifically, in vivo in humans met with limited success. Here, we evaluated intravenous injection of monocyte-derived mature DCs that were loaded with a synthetic NKT cell ligand, α-galactosyl-ceramide (α-GalCer; KRN-7000) in five patients who had advanced cancer. Injection of α-GalCer–pulsed, but not unpulsed, dendritic cells (DCs) led to >100-fold expansion of several subsets of NKT cells in all patients; these could be detected for up to 6 mo after vaccination. NKT activation was associated with an increase in serum levels of interleukin-12 p40 and IFN-γ inducible protein-10. In addition, there was an increase in memory CD8(+) T cells specific for cytomegalovirus in vivo in response to α-GalCer–loaded DCs, but not unpulsed DCs. These data demonstrate the feasibility of sustained expansion of NKT cells in vivo in humans, including patients who have advanced cancer, and suggest that NKT activation might help to boost adaptive T cell immunity in vivo

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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

Surviving, coping or thriving? understanding coping and its impact on social well-being in Mozambique

This paper presents the empirical interrogation and development of the concept of coping strategies through the findings of a piece of qualitative research which used this concept to understand and promote social well-being with young women in Mozambique during unintended pregnancy. Concepts and theories of ‘coping’ during adverse life events or periods of stress can be used to reinforce capabilities and strengths, facilitating rather than constraining people's own mechanisms of resilience. However, the framework within which the concept is situated is frequently ill-defined, particularly in applied contexts. ‘Coping strategies’ are used in many models of social work practice (preventative, remedial, rehabilitative, strengths-based, recovery-ordinated, developmental), yet understandings of what it means to ‘cope’, whether it be about counter-balancing threat, ‘getting by’ or ‘getting on’, and how such coping is strategic, are crucial for determining how the concept is used by practitioners and policy makers. Research findings based on qualitative interviews with young women (fifteen to nineteen-year-olds) and key informants in Mozambique on the concept of coping strategies are used to develop a typology which will help academics, policy makers and practitioners unpick the underlying assumptions associated with the concept