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

Age and gender influence healthy eating and physical activity behaviours in South African adolescents and their caregivers: Transforming Adolescent Lives through Nutrition Initiative (TALENT).

Objective:To: (i) understand facilitators and barriers to healthy eating practices and physical activity in younger and older urban adolescent South African boys and girls; and (ii) understand how the views of caregivers interact with, and influence, adolescent behaviours.Design:Semi-structured focus group discussions (FGD) were conducted in July 2018. Data were analysed using thematic analysis.Setting:Soweto, Johannesburg, South Africa.Participants:Seventy-five participants were stratified into eight FGD as follows: two for young boys and girls (10–12 years); two for older boys and girls (15–17 years); two for caregivers of young adolescents (boys and girls); and two for caregivers of older adolescents (boys and girls).Results:Unlike their caregivers, adolescents were not motivated to eat healthily and failed to appreciate the need to develop consistent patterns of both healthy eating and physical activity for their long-term health. Although adolescents gained independence with age, they commonly attributed unhealthy food choices to a lack of autonomy and, thereby, to the influence of their caregivers. Adolescents and caregivers perceived their engagement in physical activity according to distinct siloes of recreational and routine activity, respectively. Both similarities and differences in the drivers of healthy eating and physical activity exist in adolescents and caregivers, and should be targeted in future interventions.Conclusions:Our study identified a complex paradigm of eating practices and physical activity in South African adolescents and their caregivers. We also highlighted the need for a new narrative in addressing the multifaceted and interrelated determinants of adolescent health within urban poor settings

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