Locating the place and meaning of physical activity in the lives of young people from low-income, lone-parent families

Background: In the United Kingdom (UK), it is predicted that economic cuts and a subsequent increase in child poverty will affect those already on the lowest incomes and, in particular, those living in lone-parent families. As a result, the informal pedagogic encounters within the family that contribute to the development of physical activity-related values, beliefs and dispositions from a very early age will be affected. Therefore, it is vital that we gain an understanding of the place and meaning of physical activity in the lives of young people, as well as the informal pedagogic practices and the socio-cultural forces that influence individual agency. Purpose: Based on Bourdieu's key concepts, this paper explores the interplay of structural conditions and personal agency with regard to physical activity in the lives of young people from low-income, lone-parent families. Methods: This study reports on the voices of 24 participants (aged 11–14) from low-income, lone-parent families in the West Midlands, UK. These participants were engaged in paired, semi-structured interviews to explore issues of personal agency by listening to how they reported on their present lives, past experiences and future possibilities with regard to physical activity. All corresponding interview data were analysed using analytical induction. Findings: This paper suggests that young people exhibited diminished desires to engage in activity due to structural constraints of time, parents' work commitments and a lack of transport that resulted in engagement in sedentary alternatives. Informal pedagogic practices within these families were restricted due to the associated structural conditions of living in a lone-parent family. As such, young people's choice to not seek out physical activities when at home reflected a ‘taste for necessity’ resulting from a lack of cultural and economic capital, placing restrictions on physical activity opportunities that stemmed from their family doxa. Conclusions: To succeed in fostering dispositions and opportunities to participate in physical activity, we must engage with young people from low-income, lone-parent families from an early age. Certainly though, further consideration of the informal pedagogic practices within, and the demands on, lone-parent families is required when designing any intervention or policy that seeks to enhance their current circumstances and provide opportunities for engagement in a variety of contexts

Evolving water point mapping to strategic decision making in rural Malawi

There is a need to evolve from the simple mapping of water points, now often numerous, to effective decision making using these data. This paper outlines new developments of mWater as the preferred online Management Information System (MIS) tool to analyse significant volumes of water and sanitation data in Malawi. mWater exemplifies an evolving strategic decision-making tool used to formulate rural water supply investment strategies. A time series of 25,000 water points have been mapped since 2011 to build a complete asset register of water infrastructure to support government endeavours to reach Sustainable Development Goal 6. This comprehensive live database allows real-time analysis of over sixty variables, including linkage to concurrent mWater sanitation and waste data. This paper briefly illustrates several emergent uses of the facility to exemplify its potential in strategic decision making using Big Data. It is currently being rolled out across the entire country

Pursuing concordance: moving away from paternalism

In the second of two articles exploring the value and application of concordance across nursing practice the discussion is aimed at clinical settings and patient groups where concordance may have been viewed as impractical. The author harnesses Cribb and Entwhistle's broader conception of shared decision making and the notion of decision-making capacity as a continuum to argue that concordance can be pursued effectively in challenging settings such as childcare practice, mental health and the care of older people. As in the first paper (McKinnon, 2013) the discussion is not limited to medicines management but remains engaged with all aspects of nursing practice. Legal and ethical frameworks, social participation theory and research across healthcare practice are sourced to argue for concordant approaches in the care of patients who may at times have compromised decision-making capacity. Ideas of direct and indirect concordance are explored. © 2014 MA Healthcare Ltd

Prevalence, reasons, and timing of decisions to withhold/withdraw life-sustaining therapy for out-of-hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation

Background　Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR. Methods　We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan. Adult patients who underwent ECPR for OHCA with medical causes were included. The prevalence, reasons, and timing of WLST decisions were recorded. Outcomes of patients with or without WLST decisions were compared. Further, factors associated with WLST decisions were examined. Results　We included 1660 patients in the analysis; 510 (30.7%) had WLST decisions. The number of WLST decisions was the highest on the first day and WSLT decisions were made a median of two days after ICU admission. Reasons for WLST were perceived unfavorable neurological prognosis (300/510 [58.8%]), perceived unfavorable cardiac/pulmonary prognosis (105/510 [20.5%]), inability to maintain extracorporeal cardiopulmonary support (71/510 [13.9%]), complications (10/510 [1.9%]), exacerbation of comorbidity before cardiac arrest (7/510 [1.3%]), and others. Patients with WLST had lower 30-day survival (WLST vs. no-WLST: 36/506 [7.1%] vs. 386/1140 [33.8%], p ConclusionFor approximately one-third of ECPR/OHCA patients, WLST was decided during admission, mainly because of perceived unfavorable neurological prognoses. Decisions and neurological assessments for ECPR/OHCA patients need further analysis

Reusability of filtering facepiece respirators after decontamination through drying and germicidal UV irradiation.

During pandemics, such as the SARS-CoV-2, filtering facepiece respirators plays an essential role in protecting healthcare personnel. The recycling of respirators is possible in case of critical shortage, but it raises the question of the effectiveness of decontamination as well as the performance of the reused respirators. Disposable respirators were subjected to ultraviolet germicidal irradiation (UVGI) treatment at single or successive doses of 60 mJ/cm <sup>2</sup> after a short drying cycle (30 min, 70°C). The germicidal efficacy of this treatment was tested by spiking respirators with two staphylococcal bacteriophages (vB_HSa_2002 and P66 phages). The respirator performance was investigated by the following parameters: particle penetration (NaCl aerosol, 10-300 nm), scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry and mechanical tensile tests. No viable phage particles were recovered from any of the respirators after decontamination (log reduction in virus titre >3), and no reduction in chemical or physical properties (SEM, particle penetrations <5%-6%) were observed. Increasing the UVGI dose 10-fold led to chemical alterations of the respirator filtration media (FTIR) but did not affect the physical properties (particle penetration), which was unaltered even at 3000 mJ/cm <sup>2</sup> (50 cycles). When respirators had been used by healthcare workers and undergone decontamination, they had particle penetration significantly greater than never donned respirators. This decontamination procedure is an attractive method for respirators in case of shortages during a SARS pandemic. A successful implementation requires a careful design and particle penetration performance control tests over the successive reuse cycles

Antibiotic use for community-acquired pneumonia in neonates and children: WHO evidence review.

Background Pneumonia is the most common cause of death in children worldwide, accounting for 15% of all deaths of children under 5 years of age. This review summarises the evidence for the empirical antibiotic treatment of community-acquired pneumonia in neonates and children and puts emphasis on publications since the release of the previous WHO Evidence Summary report published in 2014. Methods A systematic search for systematic reviews and meta-analyses of antibiotic therapy for community-acquired pneumonia was conducted between 1 January 2013 and 10 November 2016. Results The optimal dosing recommendation for amoxicillin remains unclear with limited pharmacological and clinical evidence. There is limited evidence from surveillance to indicate whether amoxicillin or broader spectrum antibiotics (e.g. third-generation cephalosporins) are being used most commonly for paediatric CAP in different WHO regions. Data are lacking on clinical efficacy in the context of pneumococcal, staphylococcal and mycoplasma disease and the relative contributions of varying first-line and step-down options to the selection of such resistance. Conclusion Further pragmatic trials are required to optimise management of hospitalised children with severe and very severe pneumonia

Improving resilience management for critical infrastructures\u2014strategies and practices across air traffic management and healthcare

Recent natural and man-made disasters highlight that a more resilient approach to preparing for and dealing with such events is needed. To address this challenge, the main objective of the research and innovation H2020 project DARWIN is the development of European resilience management guidelines for Critical Infrastructures (CI). Based on a systematic literature survey with a world-wide scope and prioritization of resilience concepts, the guidelines have been developed taking into account everyday operations, contingency plans, training, etc. This paper describes insights gained from the adaptation of these guidelines in the domains of Air Traffic Management (ATM) and Healthcare (HC). A collaborative and iterative process has been defined involving relevant experts and practitioners. To ensure transnational, cross-sector applicability and uptake, a Community of Crisis and Resilience Practitioners (DARWIN DCoP) has been involved. The preliminary results indicate that a big step has been taken in moving from the resilience theory to practice. organization in the creation, assessment or improvement of its own reference guidelines, procedures and practices

Making the case for improved planning, construction and testing of water supply infrastructure in Malawi

Detailed surveys of poorly functioning rural water supply points (boreholes fitted with handpumps) in the Southern Region of Malawi show that poor functionality is most commonly caused by a) poor water resource (quantity and quality) and b) sub-standard borehole construction. Only 24% of surveyed water points showed problems caused by poor handpump operation, maintenance and management. The majority of problems observed are caused by sub-standard construction of water points prior to commissioning for use, and are typically permanent and irremediable. These issues are contributing to excessive service delivery costs through a) extended down times, b) disproportionate maintenance requirements and c) abandoned infrastructure; the resulting burden precipitates the failure of community based management approaches. This burden could be dramatically reduced by ensuring water points are proven to comply with Malawian Government standards, prior to commissioning for use. Water points not meeting these standards must not be commissioned for use

Utilisation of sexual health services by female sex workers in Nepal

Background The Nepal Demographic Health Survey (NDHS) in 2006 showed that more than half (56%) of the women with sexually transmitted infections (STIs), including HIV, in Nepal sought sexual health services. There is no such data for female sex workers (FSWs) and the limited studies on this group suggest they do not even use routine health services. This study explores FSWs use of sexual health services and the factors associated with their use and non-use of services. Methods This study aimed to explore the factors associated with utilisation of sexual health services by FSWs in the Kathmandu Valley of Nepal, and it used a mixed-method approach consisting of an interviewer administered questionnaire-based survey and in-depth interviews. Results The questionnaire survey, completed with 425 FSWs, showed that 90% FSWs self-reported sickness, and (30.8%) reported symptoms of STIs. A quarter (25%) of those reporting STIs had never visited any health facilities especially for sexual health services preferring to use non-governmental clinics (72%), private clinics (50%), hospital (27%) and health centres (13%). Multiple regression analysis showed that separated, married and street- based FSWs were more likely to seek health services from the clinics or hospitals. In- depth interviews with 15 FSWs revealed that FSWs perceived that personal, structural and socio-cultural barriers, such as inappropriate clinic opening hours, discrimination, the judgemental attitude of the service providers, lack of confidentiality, fear of public exposure, and higher fees for the services as barriers to their access and utilisation of sexual health services. Conclusion FSWs have limited access to information and to health services, and operate under personal, structural and socio-cultural constraints. The ‘education’ to change individual behaviour, health worker and community perceptions, as well as the training of the health workers, is necessary

Factors associated with malaria vaccine uptake in Nsanje district, Malawi

Background: Malaria remains a significant global health burden affecting millions of people, children under 5 years and pregnant women being most vulnerable. In 2019, the World Health Organization (WHO) endorsed the introduction of RTS,S/AS01 malaria vaccine as Phase IV implementation evaluation in three countries: Malawi, Kenya and Ghana. Acceptability and factors influencing vaccination coverage in implementing areas is relatively unknown. In Malawi, only 60% of children were fully immunized with malaria vaccine in Nsanje district in 2021, which is below 80% WHO target. This study aimed at exploring factors influencing uptake of malaria vaccine and identify approaches to increase vaccination. Methods: In a cross-sectional study conducted in April–May, 2023, 410 mothers/caregivers with children aged 24–36 months were selected by stratified random sampling and interviewed using a structured questionnaire. Vaccination data was collected from health passports, for those without health passports, data was collected using recall history. Regression analyses were used to test association between independent variables and full uptake of malaria vaccine. Results: Uptake of malaria vaccine was 90.5% for dose 1, but reduced to 87.6%, 69.5% and 41.2% for dose 2, 3, and 4 respectively. Children of caregivers with secondary or upper education and those who attended antenatal clinic four times or more had increased odds of full uptake of malaria vaccine [OR: 2.43, 95%CI 1.08–6.51 and OR: 1.89, 95%CI 1.18–3.02], respectively. Children who ever suffered side-effects following immunization and those who travelled long distances to reach the vaccination centre had reduced odds of full uptake of malaria vaccine [OR: 0.35, 95%CI 0.06–0.25 and OR: 0.30, 95%CI 0.03–0.39] respectively. Only 17% (n = 65) of mothers/caregivers knew the correct schedule for vaccination and 38.5% (n = 158) knew the correct number of doses a child was to receive. Conclusion: Only RTS,S dose 1 and 2 uptake met WHO coverage targets. Mothers/caregivers had low level of information regarding malaria vaccine, especially on numbers of doses to be received and dosing schedule. The primary modifiable factor influencing vaccine uptake was mother/caregiver knowledge about the vaccine. Thus, to increase the uptake Nsanje District Health Directorate should strengthen communities’ education about malaria vaccine. Programmes to strengthen mother/caregiver knowledge should be included in scale-up of the vaccine in Malawi and across sub-Saharan Africa