Development and Evaluation of a Spiritual Distress Screener for Use in Healthcare Settings

Spirituality and religion can play an integral role in physical and mental health outcomes in positive and negative ways (Pargament, 2013; Rosmarin, 2018). While there are established screener items to determine positive utilization of spirituality, there are no existing screener measures for spiritual struggles. The Religious and Spiritual Struggles scale (RSS; Exline et al., 2014) is considered the gold standard for measuring spiritual struggles yet is too lengthy to be used as a screener. The present study sought to develop a brief spiritual distress screener for use in healthcare settings. Phase 1 of the study utilized secondary datasets in which the RSS was implemented across seven samples in inpatient, residential, treatment-seeking, and community-based settings. Exploratory factor analysis (EFA) was conducted on the overall sample to identify items that load highly on factors with low cross-loadings. Phase 2 utilized a community-based outpatient sample to assess internal consistency and concurrent validity of the screener using total scores of the CORE-10 and PHQ-2. Overall, this study provides a clinically relevant and easy to implement screener for use in healthcare settings that will, in turn, improve overall health and treatment outcomes for those who experience spiritual struggles

Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Tube Placement

In those cases where a PEG tube cannot be placed safely, a laparoscopic-assisted technique may be a viable option to complete the procedure

Covid, the Environment and Food Systems: Contain, Cope and Rebuild Better

The objective of this paper is to analyse impacts of COVID-19 on the nexus of food systems, the environment and sustainable development and propose ways for governments and international agencies to mitigate impacts in the short and medium term. It covers the historic period from early 2020 to early 2021 and also makes an assessment on future prospects. Although evidence is collected from all around the world, the focus is primarily on developing countries. The methods used are a review of the announced actions and preliminary findings in the academic and grey literature as well as on reliable websites from global and international institutions. By October 2020, governments around the world had invested about $12 trillion to counteract the economic effects of COVID-19. This investment could contribute to progress on the SDGs and global climate targets insofar as it was invested within a framework that supports both socio-economic recovery and sustainability. Initial analysis indicates that investments for economic recovery did not sufficiently address food security and sustainability, concentrating instead on immediate economic risk management. The global sustainable development agenda must promote the resilience and sustainability of food systems through policies and measures that: i) account for environmental thresholds and trade-offs; ii) promote food security and healthy diets; iii) enhance and protect rural livelihoods; and iv) address the inequalities and injustices that have emerged and will prevail during a post-COVID transition. National stimulus programs and the actions of international agencies must be assessed and monitored to deliver multiple benefits simultaneously and guide building back better. © Copyright © 2021 Markandya, Salcone, Hussain, Mueller and Thambi.This paper is the product of a UNEP project to investigate the links between COVID, the agri-food system and the environment. The authors acknowledge the contribution of all those working to understand the ramifications of this pandemic and their efforts to determine solutions for the welfare of our communities and environment. Special thanks are extended for comments and suggestions provided by: Doreen L. Robinson, Chief for Wildlife, UNEP Ecosystems Division; Sirini Withana, Economic and Trade Policy Unit, UNEP Economy Division; James Lomax, Food Systems and Agriculture Adviser, UNEP Ecosystems Division; Susan Mutebi-Richards, Gender Reviewer, Gender and Safeguards Unit, Policy and Programme Division; Jian Liu, Chief Scientist and Director, UNEP Science Division; Edward Barbier, University Distinguished Professor in the Department of Economics, Colorado State University, Senior Scholar in the School of Global Environmental Sustainability; Peter May, Professor titular CPDA/UFRRJ. Thanks are also due to three referees from the journal who made many suggestions that improved the paper. The FAO recommends four measures to ensure supply of agricultural inputs: reduce farmer income uncertainty; support digitization of input markets; ease movement restrictions for procuring ag inputs; maintain government support for investment in ag inputs (Food and Agriculture Organization of the United Nations, 2020g). Some countries have heeded this advice. In India, the national relief package includes the provision of 300 billion rupees ($4.5 billion) of additional emergency working capital funding for small and marginal farmers to meet post-harvest spring (Rabi) and current autumn (Kharif) requirements. Several countries, including Angola, Haiti, Kyrgyzstan, Liberia and Senegal, are providing similar financial assistance, supported in part by agencies like the World Bank to address the reduction in access to finance among farmers (World Bank, 2020b)

COVID-19 and climate change challenges or opportunities for economic recovery

The paper reviews the impact that COVID-19 has had on the ambitions of countries to meet the Paris Accord of reducing emissions to keep global temperature increases to below 2 ºC in this century. It notes that as nations recover from the crises, if no additional measures are taken, emissions of greenhouse gases will rise again and return to their old pathway as they did after previous crises. The paper proposes actions in the short and medium terms to build back differently this time and help meet the global climate challenge. © 2021, Universitat de Valencia. All rights reserved

Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: Insights from the National Research Council\u27s Biological Effects of Ionizing Radiation VII Report

Background Occupational doses from fluoroscopy-guided interventional procedures are the highest ones registered among medical staff using x-rays. The aim of the present study was to evaluate the order of magnitude of cancer risk caused by professional radiation exposure in modern invasive cardiology practice. Methods From the dosimetric Tuscany Health Physics data bank of 2006, we selected dosimetric data of the 26 (7 women, 19 men; age 46 ? 9 years) workers of the cardiovascular catheterization laboratory with effective dose N2 mSv. Effective dose (E) was expressed in milliSievert, calculated from personal dose equivalent registered by the thermoluminescent dosimeter, at waist or chest, under the apron, according to the recommendations of National Council of Radiation Protection. Lifetime attributable risk of cancer was estimated using the approach of Biological Effects of Ionizing Radiation 2006 report VII. Results Cardiac catheterization laboratory staff represented 67% of the 6 workers with yearly exposure N6 mSv. Of the 26 workers with 2006 exposure N2 mSv, 15 of them had complete records of at least 10 (up to 25) consecutive years. For these 15 subjects having a more complete lifetime dosimetric history, the median individual effective dose was 46 mSv (interquartile range = 24-64). The median risk of (fatal and nonfatal) cancer (Biological Effects of Ionizing Radiation 2006) was 1 in 192 (interquartile range = 1 in 137-1 in 370). Conclusions Cumulative professional radiological exposure is associated with a non-negligible Lifetime attributable risk of cancer for the most exposed contemporary cardiac catheterization laboratory staff

La contribución económica-ambiental de programas de conservación en México: una aplicación del Modelo Integrado Económico-Ambiental (IEEM)

En este estudio se investigan los impactos, tanto económicos como aquellos sobre el capital natural y servicios ecosistémicos, de tres programas de conservación en México. Más precisamente, se analizan el programa de pago por servicios ambientales, el programa para reducir las emisiones en el sector agrícola, silvicultura y otros usos de la tierra, y el programa de unidades de manejo para la conservación de la vida silvestre. La estimación de los beneficios de estos programas es importante para justificar su financiamiento, en un contexto en el cual los recursos públicos son cada vez más escasos. Para tal fin, se aplica el Modelo Económico-Ambiental Integrado (IEEM por sus siglas en inglés) vinculado con la modelación espacial de alta resolución de cambios en uso y cobertura de suelos y servicios ecosistémicos (IEEM+ESM). Los resultados muestran que el impacto combinado de estos tres programas sobre el producto interno bruto acumulado hasta el año 2035 es de alrededor de US$856.9 millones de dólares, mientras que el impacto sobre la riqueza es aproximadamente US$492.3 millones de dólares. En conjunto, los tres programas considerados reducen la pobreza en 1,800 individuos. IEEM+ESM permite cuantificar, además de los efectos puramente económicos, el aporte que realizan distintos servicios ecosistémicos como, por ejemplo, cultura y recreación, de abastecimiento de agua y de regulación. A modo de ejemplo, cuando se consideran los servicios ecosistémicos de regulación, el impacto conjunto de los tres programas sobre el producto interno bruto es 1.34 veces más elevado. Los resultados presentados en este estudio pueden ser de utilidad para la obtención de recursos que permitan la continuidad e, incluso, la ampliación de estos programas, considerando que contribuyen a la conservación de la biodiversidad y el capital natural, así como también al bienestar de la sociedad mexicana.Centro de Estudios Distributivos, Laborales y Sociale

Value of water in agriculture: a typology of water valuation methods and estimate of economic activity from water in agriculture and associated mutual uses in the Arkansas River Basin, Colorado, The

2013 Fall.Includes bibliographical references.The water­stressed Arkansas River Basin is experiencing a greater frequency of water transfers from agriculture to municipal and industrial uses. Removing water from agriculture may harm rural communities, impact ecosystems, and change recreation opportunities. In order to better understand the implications of transfers, the economic activity created by these water uses must be calculated. Previous water valuation efforts have neither included all stakeholder interests, nor quantified externalities of water allocation scenarios and thus do not accurately estimate the potential impact of transfers. This paper evaluates methods for calculating the value of water in agriculture, the value of water to recreational users, the economic spillovers from agriculture and recreation, and the value of environmental flows. Direct, indirect and induced economic activity from agriculture is estimated using IMPLAN; economic activity from recreation related to agricultural water is estimated using benefit transfer and IMPLAN. Implications to ecosystem benefits are described quantitatively. Impacts to economic activity in the region from potential reductions in irrigated acreage are considered, including hypothetical impacts from reduced water recreation. The results show that the vast majority of agriculture, and thus economic activity from agriculture, depends upon irrigation water. That said, irrigated crop farming makes up just 1% of employment and economic activity in the Arkansas Basin. However, the great quantities of water that are allocated to agriculture (almost 90% of all water withdrawn from basin water ways) offer recreation opportunities that generate employment and economic activity and support agro-­ecosystems that have economic and consumer surplus benefits

A regional evaluation of the effectiveness of Mexico’s payments for hydrological services.

Recent criticisms of, and financial limits on, payment for hydrologic services (PHS) programs suggest that rigorous, spatially explicit evaluations are urgently needed to improve their effectiveness in conserving forest cover and to justify payments. To evaluate the effectiveness of Mexico’s PHS programs in the Pixquiac and Gavilanes subwatersheds in central Veracruz state, we used a grid-based approach to (1) compare the suitability of national versus regional deforestation risk models in selecting the parcels that should receive payment and (2) evaluate three metrics of program effectiveness in parcels receiving PHS: forest cover loss, additionality associated with deforestation risk, and leakage. Our results suggest that the national deforestation risk model was less effective at predicting actual deforestation patterns and tended to underestimate deforestation risk vs. models run regionally. Regional analysis showed parcels receiving PHS exhibited significantly lower deforestation in plots receiving PHS (0.76% loss) vs. control areas (6.29%) between 2003 and 2013. Furthermore, we found relatively poor additionality with only 38.5% of PHS occurring in zones with high or very high deforestation probability. Finally, we did not detect significant evidence of proximal leakage in our study subwatersheds. Our findings suggest that the PHS programs in central Veracruz have helped to reduce, but not stop forest loss completely. Using increased targeting of areas with higher deforestation risk in selecting PHS areas and updated regional deforestation risk models should be helpful in evaluating and increasing the effectiveness of these programs

Implementation of a vision-screening program in rural northeastern United States

Edmund Tsui,1,2 Andrew N Siedlecki,3 Jie Deng,3 Margaret C Pollard,3 Sandolsam Cha,3 Susan M Pepin,4 Erin M Salcone4 1Department of Surgery, Dartmouth–Hitchcock Medical Center, Lebanon, NH, 2Department of Ophthalmology, New York University School of Medicine, New York, NY, 3Geisel School of Medicine at Dartmouth, Hanover, NH, 4Section of Ophthalmology, Dartmouth–Hitchcock Medical Center, Lebanon, NH, USA Background: Rural populations comprise almost 20% of the US population and face unique barriers in receiving health care. We describe the implementation of a medical student-run free vision-screening clinic as a strategy to overcome barriers in accessing eye care in New Hampshire and Vermont.Methods: Medical students were trained by an ophthalmologist to administer screening eye examinations. Patients from New Hampshire and Vermont were enrolled through a free community clinic. Screening included a questionnaire, distance and near visual acuity, extraocular movements, confrontational visual fields, and Amsler grid. Patients who met predetermined screening criteria were referred to an ophthalmologist or optometrist for further evaluation. Data including patient demographics, appointment attendance, level of education, and diagnoses were recorded and analyzed.Results: Of 103 patients (mean age of 45.5±12.3 years, 63% female), 74/103 (72%) were referred for further evaluation, and 66/74 (89%) attended their referral appointments. Abnormal ophthalmologic examination findings were observed in 58/66 (88%) patients who attended their referral appointment. Uncorrected refractive error was the most common primary diagnosis in 38% of referred patients. Other diagnoses included glaucoma suspect (21%), retinal diseases (8%), amblyopia (8%), cataract (6%), others (6%), and normal examination (12%). Of the 8/74 (11%) referred patients who did not attend their appointments, reasons included patient cancellation of appointment, work conflicts, or forgetfulness. Patients traveled a mean distance of 16.6 miles (range: 0–50 miles) to attend screening examinations. Mean time for patients’ last effort to seek eye care was 7.1 years (range: 1–54 years).Conclusion: This study underscores the high prevalence of unmet eye care needs in a rural population. Furthermore, it demonstrates that using community health centers as a patient base for screening can yield a high referral attendance rate for this at-risk population and facilitate entrance into the eye care system in a rural setting. Keywords: vision screening, rural health, uninsure