Academic staff development as a catalyst for curriculum change towards education for sustainable development: an output perspective

Implementing education for sustainable development (ESD) in university curricula poses a new challenge to the academic system. In recent years many universities have undertaken activities towards its implementation and numerous case studies of such processes have been documented. However, it remains a great challenge to change university curricula in such a way that they are transformed into 'built-in' sustainability. How then can deep-rooted implementation be facilitated? It has been argued that learning processes which can enable transformative changes largely depend on academic staff and their capabilities and willingness to support such processes. Although there are only few examples that focus on academic staff in higher education as a starting point to bring about change, research indicates promising opportunities to do so. In this context this article describes the case of an academic staff development programme which was implemented at the Universidad Técnica del Norte (Ecuador) and analyses the extent to which such a programme has positive effects on transformative changes towards a sustainable university. The analysis of the programme shows that it not only facilitated the personal competence development of the participating academic staff and changed their teaching practice, but also that it influenced the general organisational development of the university. The results of this case study thus highlight the potential benefits of ESD academic staff development programmes in terms of their relevance for initiating individual learning processes as well as for facilitating social learning and, in this respect, confirm the idea that the competence development of academic staff is an essential prerequisite for a sustainability paradigm shift in higher education

Biodiversity and global learning

"The United Nations declared 2010 the International Year of Biodiversity. This emphasis on the significance of biodiversity for human existence and well-being reveals just how important expanding biodiversity conservation really is. Against this background the question arises as to how much global learning can contribute to maintaining biodiversity." (author's abstract

“More than scaling up”: a critical and practical inquiry into operationalizing sustainability competencies

This chapter starts from the UN Decade of Education for Sustainable Development (DESD) Final Report’s call that in Higher Education, ‘more than scaling up of good practice’ and ‘greater attention to systemic approaches to curriculum change and capacity building for leaders will be needed’ (UNESCO 2014a, p. 31). It recognises this need and the additional, rather profound reform and transformation of educational policy and practice that is required to meet the heightened expectations of education in an increasingly volatile, conflict laden, and challenging world. The emphasis is on clarification and framing of work to date and identification of relevant research gaps. In particular, it addresses the current status of the literature on competencies in ESD, which is characterised by a sea of labels, terminological confusion, and relative inattention to pedaogogic implications. The research outlined is both a critical inquiry into the status of work to date on sustainability competencies and a practical inquiry into the possibility of innovative and transformative institutional strategies and pedagogies around a suite of specific competencies. To this end, the early stages of an international and cross-institutional pilot project collaboration designed to help realize the UN’s ambitious Sustainable Development Goals (SDGs) and UNESCO’s Global Action Plan (GAP) (UNESCO 2014b), is described briefl

‘More than scaling-up’: Sustainability contexts, competencies, and consequences - a critical inquiry

To identify and problematise the key issues characterising the relationship between global sustainability contexts and the limited response of HE to date - with the purpose of unlocking the potential for innovative, replicable efforts to develop sustainability competencies through innovation in curriculum policy and practice, through addressing these sub-aims: How far does HE policy accommodate and reflect the need for sustainability competencies? How can capacity for teaching for competency be built and supported through new policies? How can curricula and pedagogy be better aligned to facilitate the building of sustainability competency in learners and teachers? What effect and influence does education for sustainability competency have in terms of facilitating transformative social learning, supporting systems structure change, and cultivating informed responsibility (in terms of policy and everyday decision making)?PedRI

The Psychosocial Context Impacts Medication Adherence After Acute Coronary Syndrome

Background Depression is associated with poor adherence to medications and worse prognosis in patients with acute coronary syndrome (ACS). Purpose To determine whether cognitive, behavioral, and/or psychosocial vulnerabilities for depression explain the association between depression and medication adherence among ACS patients. Methods One hundred sixty-nine ACS patients who agreed to have their aspirin adherence measured using an electronic pill bottle for 3 months were enrolled within 1 week of hospitalization. Linear regression was used to determine whether depression vulnerabilities predicted aspirin adherence after adjustment for depressive symptoms, demographics, and comorbidity. Results Of the depression vulnerabilities, only role transitions (beta = −3.32; P = 0.02) and interpersonal conflict (beta -3.78; P = 0.03) predicted poor adherence. Depression vulnerabilities did not mediate the association between depressive symptoms and medication adherence. Conclusions Key elements of the psychosocial context preceding the ACS including major role transitions and conflict with close contacts place ACS patients at increased risk for poor medication adherence independent of depressive symptoms

The Effect of Enhanced Depression Care on Anxiety Symptoms in Acute Coronary Syndrome Patients: Findings from the COPES Trial

Similar to depression, anxiety is common after acute coronary syndromes (ACS), and is an independent predictor of worse outcomes [1,2,3]. Yet, post-ACS psychological interventions have focused on treating depression. We previously reported that an enhanced depression care intervention involving patient preference for problem-solving therapy (PST), antidepressant medications, or both followed by stepped care according to treatment response was effective at reducing depressive symptoms after ACS with an effect size of 0.59 SD [4]. We report here the independent effect of this intervention on anxiety

Treating persistent depressive symptoms in post-ACS patients: The project COPES phase-I randomized controlled trial

Depression and sub-syndromal depressive symptoms are important predictors of morbidity and mortality after acute coronary syndrome (ACS). Prior trials of depression treatment in post-ACS patients have demonstrated no improvement for event-free survival, and only modest improvement in depression symptoms. These trials have raised a number of important issues regarding timing of depression intervention, acceptability of depression treatment to ACS patients, and safety for subsets of the treated population. This article describes Project COPES (Coronary Psychosocial Evaluation Studies), a multi-center Phase-I randomized clinical trial. Project COPES uses a patient preference depression treatment that has previously been found acceptable to medical patients, and a 3-month pre-randomization observation period to insure depression status. The study sample will include 200 post-ACS patients. The primary outcome is patient satisfaction with depression care. Secondary, exploratory aims include the acceptability of depression treatment, reduction in depressive symptoms, and the effects of treatment on two key pathways – medication adherence and inflammation – hypothesized to link depression to post-ACS prognosis. These analyses will provide important data to inform subsequent clinical trials with this population

Is Depression After an Acute Coronary Syndrome Simply a Marker of Known Prognostic Factors for Mortality?

Objective: Controversy remains over whether the association between depression and mortality in patients with acute coronary syndrome (ACS) is confounded by incomplete adjustment for measures of known prognostic markers. We assessed a) whether depression was associated with the most comprehensive empirically derived index of clinical mortality predictors: the Global Registry of Acute Coronary Events (GRACE) risk score for predicting 6-month mortality after discharge for ACS; and b) whether depression remained an independent predictor of all-cause mortality after adjustment for the GRACE score and left ventricular dysfunction. Methods: We surveyed prospectively 457 patients with ACS (aged 25–92 years; 41% women, 13% black, and 11% Hispanic), hospitalized between May 2003 and June 2005. Depressive symptoms were assessed with the Beck Depression Inventory (BDI) and diagnosis of major depressive disorder (MDD) was made by a structured psychiatric interview, within 1 week of hospitalization. Results: Despite differences in individual components of the GRACE score between depressed and nondepressed participants, neither depression measure was associated with overall GRACE score. For participants with MDD, the mean ± standard deviation GRACE score was 84 ± 33, compared with 92 ± 31 for those without MDD (p = .09). Using Cox proportional hazards regression analysis, MDD and depressive symptom severity each predicted mortality after controlling for GRACE score and left ventricular dysfunction (adjusted hazard ratio for MDD = 2.51; 95% Confidence Interval = 1.45–4.37). Conclusion: Depression is not simply a marker of clinical indicators that predict all-cause mortality after ACS. This strengthens the assertion that there is something unique in the association between depression and post-ACS prognosis, independent of known prognostic markers

Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes

Background: The persistence of depressive symptoms after hospitalization is a strong risk factor for mortality after acute coronary syndromes (ACS). Poor adherence to secondary prevention behaviors may be a mediator of the relationship between depression and increased mortality. Objective: To determine whether rates of adherence to risk reducing behaviors were affected by depressive status during hospitalization and 3 months later. Design: Prospective observational cohort study. Setting: Three university hospitals. Participants: Five hundred and sixty patients were enrolled within 7 days after ACS. Of these, 492 (88%) patients completed 3-month follow-up. Measurements: We used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and 3 months after discharge. We assessed adherence to 5 risk-reducing behaviors by patient self-report at 3 months. We used χ2 analysis to compare differences in adherence among 3 groups: persistently nondepressed (BDI<10 at hospitalization and 3 months); remittent depressed (BDI ≥10 at hospitalization; <10 at 3 months); and persistently depressed patients (BDI ≥10 at hospitalization and 3 months). Results: Compared with persistently nondepressed, persistently depressed patients reported lower rates of adherence to quitting smoking (adjusted odds ratio [OR] 0.23, 95% confidence interval [95% CI] 0.05 to 0.97), taking medications (adjusted OR 0.50, 95% CI 0.27 to 0.95), exercising (adjusted OR 0.57, 95% CI 0.34 to 0.95), and attending cardiac rehabilitation (adjusted OR 0.5, 95% CI 0.27 to 0.91). There were no significant differences between remittent depressed and persistently nondepressed patients. Conclusions: Persistently depressed patients were less likely to adhere to behaviors that reduce the risk of recurrent ACS. Differences in adherence to these behaviors may explain in part why depression predicts mortality after ACS. Key Words: cardiovascular diseases, depression, medication adherence, prevention, self car

Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depressive Symptoms

BACKGROUND: Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS. METHODS: A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month randomized controlled trial. From January 1, 2005, through February 29, 2008, 237 patients with ACS from 5 hospitals were enrolled, including 157 persistently depressed patients randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients) and 80 nondepressed patients who underwent observational evaluation. The primary outcome was patient satisfaction with depression care. Secondary outcomes were depressive symptom changes (assessed with the Beck Depression Inventory), major adverse cardiac events, and death. RESULTS: At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio, 5.4; 95% confidence interval [CI], 2.2-12.9 [P < .001]). The Beck Depression Inventory score decreased significantly more (t(155) = 2.85 [P = .005]) for intervention patients (change, -5.7; 95% CI, -7.6 to -3.8; df = 155) than for usual care patients (change, -1.9; 95% CI, -3.8 to -0.1; df = 155); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively; log-rank test, chi(2)(1) = 3.93 [P = .047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, chi(2)(1) = 0.48 [P = .49]). CONCLUSION: Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis