ATTITUDES AND MANAGING ALCOHOL PROBLEMS IN GENERAL PRACTICE: AN INTERACTION ANALYSIS BASED ON FINDINGS FROM A WHO COLLABORATIVE STUDY

Aims: To determine if GPs' attitudes towards working with drinkers moderated the impact that training and support had on screening and brief intervention activity in routine practice. Methods: Subjects were 340 GPs from four countries who were part of a World Health Organization randomized controlled trial to evaluate the effectiveness of training and support in increasing screening and brief alcohol intervention. GPs' self-reported attitudes towards working with drinkers were measured with the Shortened Alcohol and Alcohol Problems Perception Questionnaire. Results: Whereas training and support increased GPs' screening and brief intervention rates, it did so only for practitioners who already felt secure and committed in working with drinkers. Training and support did not improve attitudes towards working with drinkers and, moreover, worsened the attitudes of those who were already insecure and uncommitted. Conclusions: To enhance the involvement of GPs in the management of alcohol problems, interventions that increase both actual experience and address practitioners' attitudes is required. Such support could take the form of on-site support agents and facilitator

Let's agree to agree : effects of self-awareness and social identity on online deliberation

This experiment assesses the effects of ingroup versus outgroup communication in an online, one-on-one, anonymous setting on perceptions of deliberation quality in a conversation task pertaining to abortion policy. Additionally, the study examines the effects of different secondary goals during converstion tasks--those of persuasion, and those of other-awareness, or understanding--in concert with trait online disinhibition tendencies in individuals. Finally, outcomes related to perceptions of one's conversation partner (civility, intelligence, rationality, hostility, and others), perceived compromise, feelings of political deliberation cynicism, and accuracy of other awareness (i.e., ability to correctly recall a partner's abortion-related attitudes gleaned through conversation) were also measured. Many similar studies have found that the majority of online hostility will be committed by, accepted by, or even expected by those with higher levels of toxic online disinhibition--but as of yet, there has been relatively little research that inquires how civility can be encouraged in those predisposed to such toxic behaviors online. Notably, this study finds that those with higher levels of toxic, but not benign, online disinhibition prior to the task are capable of engaging amicably in deindividuated, anonymous online settings if their partner demonstrates a commitment to rationality even more than civility or intelligence, and at the same time does not compromise too easily.Includes bibliographical reference

Gender balance in committees and how it impacts participation : evidence from Costa Rica's legislative assembly

Artículo originalWe examine participation by women and men in legislatures in a critical case. Previous studies found that women often participate less than men in committee hearings and plenary debates. Yet these studies were conducted in cases where women held a fairly small share of seats and generally did not hold leadership positions or have seniority – factors expected to decrease participation. We use data from the Costa Rican Legislative Assembly (2010-2012) to assess whether women still participate less than men when placed in conditions of (near) institutional equality. Costa Rica has a successful 40% gender quota, a woman president, and no immediate reelection to the Assembly so all deputies lack seniority, thus many sex barriers have been broken in Costa Rican politics. In this apparently favorable environment, do women deputies participate equally with men? We answer this question using data from two standing committees, which offer variance on the percentage of women in attendance at each session. Empirical findings suggest that women participate as much as men in committee, even when the number of women on the committee is few. We also find that committee leaders are very active participants, which underscores the importance for women of obtaining committee leadership positions

A retrospective analysis of survival and prognostic factors after stereotactic radiosurgery for aggressive meningiomas

BACKGROUND: While most meningiomas are benign, aggressive meningiomas are associated with high levels of recurrence and mortality. A single institution’s Gamma Knife radiosurgical experience with atypical and malignant meningiomas is presented, stratified by the most recent WHO classification. METHODS: Thirty-one patients with atypical and 4 patients with malignant meningiomas treated with Gamma Knife radiosurgery between July 2000 and July 2011 were retrospectively reviewed. All patients underwent prior surgical resection. Overall survival was the primary endpoint and rate of disease recurrence in the brain was a secondary endpoint. Patients who had previous radiotherapy or prior surgical resection were included. Kaplan-Meier and Cox proportional hazards models were used to estimate survival and identify factors predictive of recurrence and survival. RESULTS: Post-Gamma Knife recurrence was identified in 11 patients (31.4%) with a median overall survival of 36 months and progression-free survival of 25.8 months. Nine patients (25.7%) had died. Three-year overall survival (OS) and progression-free survival (PFS) rates were 78.0% and 65.0%, respectively. WHO grade II 3-year OS and PFS were 83.4% and 70.1%, while WHO grade III 3-year OS and PFS were 33.3% and 0%. Recurrence rate was significantly higher in patients with a prior history of benign meningioma, nuclear atypia, high mitotic rate, spontaneous necrosis, and WHO grade III diagnosis on univariate analysis; only WHO grade III diagnosis was significant on multivariate analysis. Overall survival was adversely affected in patients with WHO grade III diagnosis, prior history of benign meningioma, prior fractionated radiotherapy, larger tumor volume, and higher isocenter number on univariate analysis; WHO grade III diagnosis and larger treated tumor volume were significant on multivariate analysis. CONCLUSION: Atypical and anaplastic meningiomas remain difficult tumors to treat. WHO grade III diagnosis and treated tumor volume were significantly predictive of recurrence and survival on multivariate analysis in aggressive meningioma patients treated with radiosurgery. Larger tumor size predicts poor survival, while nuclear atypia, necrosis, and increased mitotic rate are risk factors for recurrence. Clinical and pathologic predictors may help identify patients that are at higher risk for recurrence

A New Era in Mental Health Care in Vanuatu

Inequity in health-care delivery for those with mental illness is widespread throughout low- and middle-income countries. In the Pacific Island countries there are many barriers to addressing the growing mental health burden. In an effort to address this problem, the WHO is coordinating the Pacific Islands Mental Health Network involving 18 countries in the Pacific region with the financial support of New Zealand Aid (NZAid). JB and DP have developed and presented mental health training to health professionals, community leaders, and social service personnel in an environment in Vanuatu that is very different from that of their usual Australian-based general practices. They discuss evidence for their work, an outline of the programme, some difficulties working across different cultures, and the enthusiasm with which the training has been greeted. Vanuatu is now well on its way to addressing the inequity of access to mental health care with a culturally appropriate and self-sustaining mental health workforce

Building a Leadership Culture for Environmental Health in a Nurse-Led Clinic

Climate change is the biggest global health threat of the 21st century (Costello et al., 2009). Temperature shifts caused by greenhouse gases have negative health impacts such as worsening of chronic diseases and increases in vector-borne diseases (American Public Health Association, 2016), which nurses are ethically responsible to address (American Nurses Association, 2015). At an interdisciplinary nurse-led clinic, staff were not prepared to assist patients in building resiliency related to the health impacts of climate change or to implement environmental sustainability in their workplace. Based on principles of partnership-based healthcare (Eisler & Potter, 2014), this project included Climate Conversations - sharing stories, values, and knowledge about climate change – (Minnesota Interfaith Power & Light, 2010) and evidence-based transformational leadership. The Nurses’ Environmental Awareness Tool (Schenk et al., 2015) was used to survey staff before and after they participated in behavioral interventions to incorporate environmental sustainability at their workplace. Compared to baseline, staffs’ knowledge of environmental sustainability increased significantly (p

Home care clients: a research protocol for studying their pathways

Abstract Background Enhancing non-clinical home care supports and services for older adults to live well is a strategic priority in developed countries, including Canada. Underpinning these supports and services are structures of care that are reflected in home care policies, programs and practices within jurisdictions. These approaches to care exist at multiple levels and inform interactions, perceptions, and care assessment, planning and provision, ultimately shaping the supports that are delivered. Jurisdictional differences in approaches to care mean that pathways through home care systems may differ, depending on where one lives. The goal of this study is to understand how approaches to care shape the pathways of older adult home care clients with chronic and long term conditions in two Canadian health jurisdictions. Methods This longitudinal mixed-methods study has three interrelated research streams informed by aspects of the socio-ecological framework. We will examine client pathways using a retrospective analysis of home care assessment data (Resident Assessment Instrument- Home Care) in two health authorities (Client/Service Data Stream). We will analyze interview data from older adult home care clients and a cluster of each client’s family or friend caregiver(s), home support worker(s), care/case coordinator(s) and potentially other professionals at up to three points over 18 months using a prospective qualitative comparative case study design (Constellation Data Stream). We will review home care policies relevant to both health authorities and interview key informants regarding the creation and implementation of policies (Policy Stream). Our study will apply an integrated knowledge translation (iKT) approach that engages knowledge users in research design, analysis and interpretation to facilitate relevancy of results. Discussion Applying a mixed-method research design to understand approaches to care within and between two jurisdictions will contribute to the evidence base on older adult home care client pathways. Study results will identify how potential differences are experienced by clients and their families. An understanding of the policies will help to contextualize these findings. The iKT model will ensure that findings are useful for strategic planning and decision-making, and supporting changes in care practice

Profiling the types of restaurants that sell wild meat in Central African cities

Central African cities are major centres of demand for wild meat, even when affordable alternative proteins are widely available. Many people eat wild meat in restaurants; therefore, restaurateurs are well placed to provide insights into the wild meat trade and consumer preferences. We surveyed 326 restaurants in Brazzaville and Kinshasa, the adjoining capital cities of the Republic of Congo and Democratic Republic of the Congo, to determine which types of restaurants sell wild meat, how sales of wild meat dishes compared with those containing other proteins, and the importance of wild meat to these businesses. The majority of wild meat-selling restaurants are informal establishments owned by women. Although most only sell wild meat dishes weekly, we estimate that nearly 10,000 wild meat dishes are consumed daily in restaurants across Brazzaville and Kinshasa. Its wide availability reinforces the social norm around eating wild meat, yet few restaurateurs considered wild meat to be central to the viability of their business. It is important to distinguish between restaurants reliant on wild meat sales and those that offer it to diversify their menus. Forging partnerships with restaurateurs offer untapped potential to develop mutually beneficial allegiances to further wild meat demand reduction efforts

An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia

<p>Abstract</p> <p>Background</p> <p>Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia.</p> <p>Methods</p> <p>The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached.</p> <p>Results</p> <p>All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities.</p> <p>Conclusions</p> <p>Six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.</p

Implementation of the World Health Organization's QualityRights initiative in Ghana: an overview

Background Globally, human rights violations experienced by persons with psychosocial, intellectual or cognitive disabilities continue to be a concern. The World Health Organization's (WHO) QualityRights initiative presents practical remedies to address these abuses. This paper presents an overview of the implementation of the initiative in Ghana.Aims The main objective of the QualityRights initiative in Ghana was to train and change attitudes among a wide range of stakeholders to promote recovery and respect for human rights for people with psychosocial, intellectual and cognitive disabilities.Method Reports of in-person and online training, minutes of meetings and correspondence among stakeholders of the QualityRights initiative in Ghana, including activities of international collaborators, were analysed to shed light on the implementation of the project in Ghana.Results In-person and online e-training on mental health were conducted. At the time of writing, 40 443 people had registered for the training, 25 416 had started the training and 20 865 people had completed the training and obtained a certificate. The team conducted 27 in-person training sessions with 910 people. The successful implementation of the project is underpinned by a committed partnership among stakeholders, strong leadership from the coordinating agency, the acceptance of the initiative and the outcome. A few challenges, both in implementation and acceptance, are discussed.Conclusions The exposure of the WHO QualityRights initiative to a substantial number of key stakeholders involved in mental healthcare in Ghana is critical to reducing human rights abuses for people with psychosocial, intellectual and cognitive disabilities