Supporting carers to manage pain medication in cancer patients at the end of life: A feasibility trial

Background: Carers of people with advanced cancer play a significant role in managing pain medication, yet they report insufficient information and support to do so confidently and competently. There is limited research evidence on the best ways for clinicians to help carers with medication management. Aims: To develop a pain medicines management intervention (Cancer Carers Medicines Management) for cancer patients’ carers near the end of life and evaluate feasibility and acceptability to nurses and carers. To test the feasibility of trial research procedures and to inform decisions concerning a full-scale randomised controlled trial. Design: Phase I-II clinical trial. A systematic, evidence-informed participatory method was used to develop CCMM: a nurse-delivered structured conversational process. A two-arm, cluster randomised controlled feasibility trial of Cancer Carers Medicines Management was conducted, with an embedded qualitative study to evaluate participants’ experiences of Cancer Carers Medicines Management and trial procedures. Setting: Community settings in two study sites. Participants: Phase I comprises 57 carers, patients and healthcare professionals and Phase II comprises 12 nurses and 15 carers. Results: A novel intervention was developed. Nurses were recruited and randomised. Carer recruitment to the trial was problematic with fewer than predicted eligible participants, and nurses judged a high proportion unsuitable to recruit into the study. Attrition rates following recruitment were typical for the study population. Cancer Carers Medicines Management was acceptable to carers and nurses who took part, and some benefits were identified. Conclusion: Cancer Carers Medicines Management is a robustly developed medicines management intervention which merits further research to test its effectiveness to improve carers’ management of pain medicines with patients at the end of life. The study highlighted aspects of trial design that need to be considered in future research

Dividend Stickiness in Japan

markdownabstract__Abstract__ The paper describes the introduction of an emphasis on ‘personal security’ in human security thinking and practice, as part of the ultimately unsuccessful attempt to compartmentalize the pursuit of security. It reviews the past twenty years of attention to ‘personal security’: both in compartments that consider organized physical violence or threats to personal safety and property (‘citizen security’), and as parts of more wide-ranging examination of threats to fulfilment of basic needs and rights, for example in comprehensive mapping exercises undertaken in various UNDP Regional and National Human Development Reports or in studies of women’s security. The paper reflects on the complex process of opening-up conventional security thinking and practice, seeking value-added and depth without shrinking into preconceived compartments

Community Willingness to Participate in a Dengue Study in Aceh Province, Indonesia

Background: Dengue virus infection is the most rapidly spreading vector-borne disease in the world. Essential research on dengue virus transmission and its prevention requires community participation. Therefore, it is crucial to understand the factors that are associated with the willingness of communities in high prevalence areas to participate in dengue research. The aim of this study was to explore factors associated with the willingness of healthy community members in Aceh province, Indonesia, to participate in dengue research that would require phlebotomy. Methodology/Principal Findings: A community-based cross-sectional study was carried out in nine regencies and municipalities of Aceh from November 2014 to March 2015. Interviews using a set of validated questionnaires were conducted to collect data on demography, history of dengue infection, socioeconomic status, and knowledge, attitude and practice regarding dengue fever. Two-step logistic regression and Spearman's rank correlation (rs) analysis were used to assess the influence of independent variables on dependent variables. Among 535 participants, less than 20% had a good willingness to participate in the dengue study. The factors associated with good willingness to participate were being female, working as a civil servant, private employee or entrepreneur, having a high socioeconomic status and good knowledge, attitude and practice regarding dengue. Good knowledge and attitude regarding dengue were positive independent predictors of willingness to participate (OR: 2.30 [95% CI: 1.36-3.90] and 3.73 [95% CI: 2.24-6.21], respectively). Conclusion/Significance: The willingness to participate in dengue research is very low among community members in Aceh, and the two most important associated factors are knowledge and attitude regarding dengue. To increase participation rate, efforts to improve the knowledge and attitude of community members regarding dengue fever and dengue-related research is required before such studies are launched

When not every response to climate change is a good one: identifying principles for sustainable adaptation

Climate adaptation has become a pressing issue. Yet little attention has been paid to the consequences of adaptation policies and practices for sustainability. Recognition that not every adaptation to climate change is a good one has drawn attention to the need for sustainable adaptation strategies and measures that contribute to social justice and environmental integrity. This article presents four normative principles to guide responses to climate change and illustrates the significance of the 'sustainable adaptation' concept through case studies from diverse contexts. The principles are: first, recognize the context for vulnerability, including multiple stressors; second, acknowledge that differing values and interests affect adaptation outcomes; third, integrate local knowledge into adaptation responses; and fourth, consider potential feedbacks between local and global processes. We argue that fundamental societal transformations are required in order to achieve sustainable development pathways and avoid adaptation funding going into efforts that exacerbate vulnerability and contribute to rising emissions. Despite numerous challenges involved in achieving such change, we suggest that sustainable adaptation practices have the potential to address some of the shortcomings of conventional social and economic development pathways