Improving care for people with heart failure in Uganda: serial in-depth interviews with patients' and their health care professionals

Abstract Background The short prognosis of patients with advanced heart failure (HF) and the associated multidimensional distress as illustrated in literature from high income countries necessitates the integration of palliative care into the care of advanced HF patients to address these needs and improve their quality of life. These needs, which are subjective, have not been described from the patients’ and health care professionals’(HPs) view point in the Ugandan setting, a low income country with a different socio-cultural context. This study aimed at bridging this gap in knowledge by eliciting patients’ and HPs’ views of HF patients’ needs over the course of their illness to enable generalists, cardiologists and palliative care clinicians to develop guidelines to provide patient-centred realistic care in Uganda. Methods Serial qualitative in-depth interviews were conducted with HF patients who were purposively sampled and recruited in Mulago National Referral Hospital (MNRH) until thematic saturation. In-depth interviews were conducted at three time points with intervals of 3 month between interviews over the course of their illness in the hospital and their home context. One-off interviews were conducted with HPs that manage HF in MNRH. We used a grounded theory approach in data analysis. The Uganda National Council of science and technology approved the research. Results Forty-eight interviews were conducted with 21 patients and their carers and eight interviews with their HPs. Multidimensional needs including physical, psychological, social, spiritual and information needs were identified. These highlighted the underpinning need to have normal functioning, control, to cope and adapt to a changed life and to find meaning. Spiritual needs were less recognised by HPs than the other multidimensional needs. Information needs were commonly unmet. Patients and HPs suggested improvements in care that were congruent with the recommendations in chronic disease care and the six pillars of the WHO health systems strengthening approach. Conclusion Management of HF in Uganda requires an approach that targets multidimensional needs, embraces multidisciplinary care and strengthens health systems which are all important tenets of palliative care

Asthma in goldminers

Objectives. To detennine whether asthma in goldminers is caused by or contributed to by their working environment.Design. A case-control stUdy in which men with asthma working underground in goldmines were compared with underground goldminers without asthma in relation to their age, duration of exposure to the underground environment, atopy and family history of asthmaSetting. An in- and outpatient facility providing for the medical needs of approXimately 90 000 miners employed on goldmines in the Free State.Outcome measures. Occupational history, atopy and family history of asthma were compared in the two groups. The age of onset of asthma and duration of occupational exposure were examined in the men with asthma.Results. The study sample included 78 underground miners with asthma and 46 without asthma The men in the two groups were of similar age, but those with asthma had worked underground for a longer period than the men without asthma Twenty of the asthmatic and none of the control group had been exposed to paint and cement in the course of their work. Fifty of the asthmatic and only 3 of the control group were atopic. The mean age of onset of asthma (% SO) was 30.6 % 10.73 years. Six of the men had developed asthma before starting to work in the mines, and the disease had developed 13.4 ± 8.22 years after starting to work underground in the remaining 72.Conclusion. The late age of onset and the onset after exposure to the underground environment suggest that the disease was work-related

Catalysis-Material Crosstalk at Tailored Nano-Carbon Interfaces

5noThe use of carbon nanomaterials as supports for molecular and nanostructured catalysts is becoming a more and more popular strategy to improve heterogeneous catalysis. Their outstanding electronic and optical properties together with high surface area and thermal and mechanical stabilities make them ideal elements to provide catalysts with additional or improved characteristics. The role of the carbon nanostructures in the different types of catalysis is more intricate and often involves active and strong interactions between the support and the catalytic active species, creating a synergistic effect that in many cases leads to performance enhancement and an expanded range of possible applications. In particular, photocatalysis and electrocatalysis seem to benefit from the features of these types of carbon support, although applicability can be extended to more classic transformations of organic substrates.nonenoneMelchionna, Michele; Bonchio, Marcella; Paolucci, Francesco; Prato, Maurizio; Fornasiero, PaoloMelchionna, Michele; Bonchio, Marcella; Paolucci, Francesco; Prato, Maurizio; Fornasiero, Paol

Catalysis-Material Crosstalk at Tailored Nano-Carbon Interfaces

The use of carbon nanomaterials as supports for molecular and nanostructured catalysts is becoming a more and more popular strategy to improve heterogeneous catalysis. Their outstanding electronic and optical properties together with high surface area and thermal and mechanical stabilities make them ideal elements to provide catalysts with additional or improved characteristics. The role of the carbon nanostructures in the different types of catalysis is more intricate and often involves active and strong interactions between the support and the catalytic active species, creating a synergistic effect that in many cases leads to performance enhancement and an expanded range of possible applications. In particular, photocatalysis and electrocatalysis seem to benefit from the features of these types of carbon support, although applicability can be extended to more classic transformations of organic substrates