The Role of Learning in an Aging Society with Fewer Children: Referring to Education in America and New Zealand

研究資料・報

Family-centred care for hospitalised children aged 0-12 years (Review)

This is an update of the Cochrane systematic review of family-centred care published in 2007 (Shields 2007). Family-centred care (FCC) is a widely used model in paediatrics, is thought to be the best way to provide care to children in hospital and is ubiquitous as a way of delivering care. When a child is admitted, the whole family is affected. In giving care, nurses, doctors and others must consider the impact of the child's admission on all family members. However, the effectiveness of family-centred care as a model of care has not been measured systematically. To assess the effects of family-centred models of care for hospitalised children aged from birth (unlike the previous version of the review, this update excludes premature neonates) to 12 years, when compared to standard models of care, on child, family and health service outcomes. In the original review, we searched up until 2004. For this update, we searched: the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library, Issue 12 2011); MEDLINE (Ovid SP); EMBASE (Ovid SP); PsycINFO (Ovid SP); CINAHL (EBSCO Host); and Sociological Abstracts (CSA). We did not search three that were included in the original review: Social Work Abstracts, the Australian Medical Index and ERIC. We searched EMBASE in this update only and searched from 2004 onwards. There was no limitation by language.\ua0We performed literature searches in May and June 2009 and updated them again in December 2011. We searched for randomised controlled trials (RCTs) including cluster randomised trials in which family-centred care models are compared with standard models of care for hospitalised children (0 to 12 years, but excluding premature neonates). Studies had to meet criteria for family-centredness. In order to assess the degree of family-centredness, we used a modified rating scale based on a validated instrument, (same instrument used in the initial review), however, we decreased the family-centredness score for inclusion from 80% to 50% in this update. We also changed several other selection criteria in this update: eligible study designs are now limited to randomised controlled trials (RCTs) only; single interventions not reflecting a FCC model of care have been excluded; and the selection criterion whereby studies with inadequate or unclear blinding of outcome assessment were excluded from the review has been removed. Two review authors undertook searches, and four authors independently assessed studies against the review criteria, while two were assigned to extract data. We contacted study authors for additional information. Six studies found since 2004 were originally viewed as possible inclusions, but when the family-centred score assessment was tested, only one met the minimum score of family-centredness and was included in this review. This was an unpublished RCT involving 288 children post-tonsillectomy in a care-by-parent unit (CBPU) compared with standard inpatient care.The study used a range of behavioural, economic and physical measures. It showed that children in the CBPU were significantly less likely to receive inadequate care compared with standard inpatient admission, and there were no significant differences for their behavioural outcomes or other physical outcomes. Parents were significantly more satisfied with CBPU care than standard care, assessed both before discharge and at 7 days after discharge. Costs were lower for CPBU care compared with standard inpatient care. No other outcomes were reported. The study was rated as being at low to unclear risk of bias. This update of a review has found limited, moderate-quality evidence that suggests some benefit of a family-centred care intervention for children's clinical care, parental satisfaction, and costs, but this is based on a small dataset and needs confirmation in larger RCTs. There is no evidence of harms. Overall, there continues to be little high-quality quantitative research available about the effects of family-centred care. Further rigorous research on the use of family-centred care as a model for care delivery to children and families in hospitals is needed. This research should implement well-developed family-centred care interventions, ideally in randomised trials. It should investigate diverse participant groups and clinical settings, and should assess a wide range of outcomes for children, parents, staff and health services

Assessing Patient-Provider Collaboration in Subjects with Type 2 Diabetes in Jamaica and Effects on Glycemic Control

Background: Type 2 Diabetes Mellitus is a growing health problem worldwide that places patients at increased risk of morbidity and mortality from microvascular and macrovascular complications. Research suggests that a patient-centered approach which focuses on patient-physician communication and collaboration in the management of chronic diseases such as diabetes may improve clinical outcomes in a glycemic parameter such as HbA1c. We measured the degree of this patient-centered approach in a sample population of subjects with Type 2 Diabetes in Jamaica with the use of the Patient Assessment of Care for Chronic Illness (PACIC) questionnaire and assessed the relationship between patient-centered care and glycemic control. Purpose: To compare PACIC scores to hemoglobin A1C values in subjects with Type 2 Diabetes and to determine the correlation between patient-physician collaboration and glycemic control. Methods: Participants were selected from the Diabetes Clinic at the University Hospital of the West Indies in Kingston, Jamaica, in August 2011. A total of 40 patients were screened, but only 19 met eligibility requirements and agreed to participate in the study. Informed consent was obtained. The patients were assigned a study number and then self-administered the Patient Assessment of Care for Chronic Illness (PACIC) questionnaire in a private examination room. The PACIC is a validated instrument consisting of a total of 20 multiple choice questions. It measures five subjective categories: 1) Patient activation; 2) Delivery system design and decision support; 3) Goal setting; 4) Problem solving/contextual counseling; and 5) Follow-up/ coordination. Each category can be averaged individually with scores ranging from 1-5. The overall PACIC score measures patient-physician collaboration with a score ranging from a low of 1.0 to a high of 5.0. Additional study data was collected by one of the authors (PD) for both characterization of the study population and for analysis of potential confounders. These additional independent variables included: patient age, type of treatment (i.e., lifestyle modification), and years diagnosed with diabetes mellitus. Results: There were 19 subjects who were eligible for study and completed the PACIC questionnaire. There were more women than men (78.9%, 15 women and 4 men). The age range was 33-78 years with a mean age of 55. The range for years diagnosed with diabetes was 0.03 – 32 years with a mean of 14 years. Eight of the subjects (42.1%) were on combination therapy with insulin and oral hypoglycemic agents. Hemoglobin A1c values ranged from 5.4% – 15.5% with a mean of 10.8%. The PACIC scores ranged from 1.85 – 4.80 with a mean of 3.15. No statistically significant correlations were found between PACIC scores and HbA1c (r=.184). HbA1c did not significantly correlate with patient age (r=-.408), nor with years diagnosed with diabetes (r=-.244). Further statistical analysis using non-parametric correlation coefficients to take small sample sizes into account did not reveal any significant relationship either. Conclusion: There was no statistically significant trends between our main variables of the patient-physician collaboration (PACIC score) and glycemic control (HbA1c). Analysis of potential confounders also failed to elicit any correlations with HbA1c. The major limitation in this study is the small sample size. An important next step would be to repeat this study with a larger clinic sample

“A Cathartic Moment in a Man’s Life”: Homosociality and Gendered Fun on the Puttan Tour

Rarely addressed in academic scholarship, the puttan tour is a well-known form of entertainment in Italy where young men drive around in small groups with the aim of spotting street sex workers. On some occasions, the participants will approach the sex workers to strike up a conversation. On others, they will shout out insults from their car then drive away. This article aims to advance a detailed analysis of this underexplored cultural practice drawing on a diverse body of scholarship exploring the intersection of masculinity, leisure, and homosociality. By analyzing stories of puttan tours gathered mostly online, including written accounts and YouTube videos, our aim is to explore the appeal of the puttan tour through an analysis of how homosociality, humor, and laughter operate in this example of gendered fun. To this end, we look at the multiple and often equivocal meanings of this homosocial male-bonding ritual, its emotional and affective dynamics, and the ways in which it reproduces structures of inequality while normalizing violence against sex workers

Hypoxia imaging with [18F]HX4 PET in squamous cell head and neck cancer: a pilot study for integration into treatment planning

Background: Radical chemoradiotherapy is the primary treatment for head and neck cancers in many hospitals. Tumour hypoxia causes radiotherapy resistance, and is an indicator of poor prognosis for patients. Identifying hypoxia to select patients for intensified or hypoxia-modified treatment regimens is therefore of high clinical importance. Patients and Methods: We evaluated hypoxia in a group of patients with newly diagnosed squamous cell head and neck cancer using the hypoxia-selective radiotracer [18F]HX4. Patients underwent a single [18F]HX4 PET/CT scan prior to beginning chemoradiotherapy.Results: Three out of eight patients recruited were scanned with [18F]HX4. Two out of three had pre-treatment [18F]FDGPET/CT scans available for review. [18F]HX4 tumour uptake varied between patients, with tumour to mediastinal ratios ranging from1 to3.5. Conclusions: The spectrum of [18F]HX4 uptake in this small series of patients exemplifies the difference in oxygenation profiles between histologically similar tumours. Performing an additional PET scan with [18F]HX4 prior to chemoradiotherapy treatment was logistically challenging in a routine setting, and therefore validation of its clinical impact should be the focus of future studies

A rapid scoping review of harm reduction strategies for ecstasy (MDMA) users in recreational settings

Background: Adverse drug reactions (ADRs) can occur due to ecstasy use, and the number of people dying due to drug-related deaths has increased in the past 10 years. Harm reduction strategies could help prevent ADRs or decrease the incidence of life-threatening health consequences due to ecstasy use. However, no reviews have explored the breadth of evidence available on ecstasy harm reduction strategies. Methods: A rapid scoping review was conducted using adapted JBI methodology to identify the prevalence and nature of harm reduction strategies that ecstasy users employ in recreational settings, with both peer-reviewed research and user-oriented drug information websites explored. Five databases (CINAHL, EMBASE, Medline, PsycINFO, CENTRAL) were searched for English language records from database inception to August 2022. User-oriented websites were identified via the project’s stakeholder group and Google searches. Results: Twenty reports representing 19 studies (one randomised control trial, nine quantitative descriptive studies and nine qualitative studies) were included. A wide variety of harm reduction strategies were reported, including drug-specific strategies (for example, limiting the amount of ecstasy consumed, buying from trusted sources, drug checking (pill testing)); behavioural strategies (for example, monitoring fluid (water) consumption, taking a rest break to regulate temperature, avoiding alcohol and mixing with other drugs; preloading and post-loading); and peer-related strategies (for example not using alone, looking out for friends). Ecstasy users obtain information on ecstasy’s effects and/or harm reduction practices from a variety of sources including friends, nightclubs, TV news, drug leaflets, music magazines and user-oriented information websites. Fourteen user-oriented websites providing ecstasy-specific harm reduction information were identified, and strategies focused on dosage and frequency of use, interaction with other substances and prevention of health consequences, such as heatstroke, or dehydration among others. However, only two webpages provided citations to the evidence used for the content. Conclusions: While numerous harm reduction strategies exist, employing them can depend on the users’ overall goal/s which might also encompass avoiding comedown or increasing their high. Moreover, users’ previous experience can influence how and when they adhere to harm reduction. More efficient ways of communicating harms and harm reduction strategies might be needed

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline