God's own medicine: opiods, law and the health community

The interaction among prescription drugs, medicine and the law is an intricate one, involving patients, doctors, government officials and drug representatives with ties to advocacy and professional organizations, and regulatory. Recent events, such as increasing rates of prescription drug abuse and overdose deaths and physician prosecutions, have intensified the conflict. This project, a series of news articles, examines the relationship between policy, pain and prescription drugs with perspectives from the fields of law enforcement, public health and medicine. It serves as a remedy to medical journalism that has largely been unwilling or unable to tease out the nuances of this complex relationship The project considers the ways that health and law enforcement institutions reconcile drugs that are critical in the treatment of pain, but also subject to widespread abuse. It seeks to answer the question: How does the complex relationship among prescription drugs, law enforcement and medicine affect the practice of pain and addiction medicine and the regulation of opioid drugs

Short-term effectiveness of nutrition therapy to treat type 2 diabetes in low-income and middle-income countries: systematic review and meta-analysis of randomised controlled trials

OBJECTIVES: This review examined the evidence arising from randomised controlled trials regarding the impact of nutrition therapy on glycaemic control in people living with type 2 diabetes mellitus (T2DM) in low/middle-income countries (LMICs). DESIGN: Systematic review and meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Approach. DATA SOURCES: MEDLINE, EMBASE, Web of Science, OpenGrey and the International Clinical Trials Registry were searched (up to July 3 2020). ELIGIBILITY CRITERIA: Trials were included if they evaluated nutrition therapy in adults diagnosed with T2DM, were conducted in LMICs, measured glycaemic control and the trial included a 3-month post-intervention assessment. Nutrition therapy was defined according to American Diabetes Association recommendations. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened the database. Study characteristics and outcome data were extracted using a data collection form. Meta-analyses were conducted for glycated haemoglobin (HbA1c) and fasting blood glucose. Trials were assessed for risk of bias (Cochrane Risk-of-Bias, Version 2.0) and overall certainty of evidence (GRADE). RESULTS: Four trials met inclusion criteria (total n=463), conducted in Malaysia, Iran and South Africa. All trials focused on nutrition education with no direct prescription or manipulation of diet. Mean differences between intervention and standard care were −0.63% (95% CI −1.47% to 0.21%) for HbA1c and −13.63 mg/dL (95% CI −37.61 to 10.34) for fasting blood glucose in favour of the intervention. Given the small number of eligible trials, moderate to high risk of publication bias and serious concerns regarding consistency and precision of the evidence, certainty of evidence was deemed to be very low. CONCLUSIONS: There is a lack of well-conducted randomised controlled trials that examine the long-term impact of nutrition therapy in LMICs, preventing firm conclusions to be made on their effectiveness. Further research is essential to discover realistic, evidence-based solutions. PROSPERO REGISTRATION NUMBER: CRD42020188435

Exploring support needs of people living with diabetes during the coronavirus COVID-19 pandemic: insights from a UK survey

INTRODUCTION: The coronavirus COVID-19 pandemic has radically compromised healthcare for people living with chronic conditions such as diabetes. Government-imposed restrictions to contain the spread of the virus have forced people to suddenly adjust their lifestyle. This study aimed to capture the impact of the pandemic on people living with diabetes and the views of these individuals on ways in which the information, advice and support they are receiving could be improved. RESEARCH DESIGN AND METHODS: An online anonymous survey was distributed across the UK during the first lockdown and initial easing. The survey comprised questions about confidence in diabetes self-management, resources used to obtain information, advice and support, and opinions on how these could be improved. Open-ended questions captured subjective experiences. RESULTS: The survey was completed by 773 adults with diabetes (69.2% type 1, 28.5% type 2). There was notable variability in the impact of the pandemic on confidence in self-management, with confidence having deteriorated most commonly in the ability to take care of own mental well-being (37.0% respondents) and improved most commonly in maintaining a healthy weight (21.1% respondents). 41.2% of respondents living alone reported not receiving any outside support. The quality of information, advice and support received from the healthcare team was rated poorly by 37.2%. Respondents sought greater communication and tailored advice from their care team, clear and consistent information from the government and news channels, and improved understanding of diabetes and its challenges from their personal networks and employers. CONCLUSION: Adjusting to the COVID-19 pandemic has strained the mental health and well-being of people living with diabetes. Diabetes care teams must receive assistance to support these individuals without risking further inequalities in access to healthcare. Equipping personal networks and employers with knowledge on diabetes and skills to support self-management may reduce the burden on the National Health Service

Going beyond two degrees? The risks and opportunities of alternative options

Since the mid-1990s, the aim of keeping climate change within 2 °C has become firmly entrenched in policy discourses. In the past few years, the likelihood of achieving it has been increasingly called into question. The debate around what to do with a target that seems less and less achievable is, however, only just beginning. As the UN commences a two-year review of the 2 °C target, this article moves beyond the somewhat binary debates about whether or not it should or will be met, in order to analyse more fully some of the alternative options that have been identified but not fully explored in the existing literature. For the first time, uncertainties, risks, and opportunities associated with four such options are identified and synthesized from the literature. The analysis finds that the significant risks and uncertainties associated with some options may encourage decision makers to recommit to the 2 °C target as the least unattractive course of action

The WHO UNESCO FIP Pharmacy Education Taskforce: enabling concerted and collective global action

Pharmacy Education is a priority area for the International Pharmaceutical Federation (FIP), the global federation representing pharmacists and pharmaceutical scientists worldwide that is spearheading the Global Pharmacy Education Taskforce. This paper describes the work of the Taskforce that was established in March 2008, explores key issues in pharmacy education development, and describes the Global Pharmacy Action Plan 2008-2010. Given the significance of pharmacy education to the diverse practice of contemporary pharmacists and pharmacy support personnel, there is a need for pharmacy education to attain greater visibility on the global human resources for health agenda. From this perspective, FIP is steering the development of holistic and comprehensive pharmacy education and pharmacy workforce action to support and strengthen regional, national, and local efforts. The role of a global organization such as FIP is to facilitate, catalyze, and share efforts to maximize pharmacy education development and stimulate international research to develop guidance, tools, and better understanding of key issues. To achieve this goal, FIP has (1) established a formal collaborative partnership with the 2 United Nations agencies representing the education and health sectors, United Nations Educational, Scientific and Cultural Organization (UNESCO) and the World Health Organization (WHO); and (2) established the Global Pharmacy Education Taskforce to serve as the coordinating body of these efforts. The initial effort will serve to leverage strategic leadership and maximize the impact of collective actions at global, regional, and national levels. Three project teams have been convened to conduct research, consultations and develop guidance in the domains of vision for pharmacy education, competency, quality assurance, academic workforce, and institutional capacity

The role of assistance dogs in society

Assistance dogs are specially trained to undertake a variety of tasks to help individuals with disabilities. This review gives an overview of the different types of assistance dogs in the UK, including guide dogs, hearing dogs, mobility assistance dogs, service dogs and dual purpose dogs. The literature describes many benefits of assistance dogs, including their impact on physical wellbeing and safety of their ‘owners,’ as well as on psychological wellbeing and social inclusion. The role of assistance dogs in society is widely recognized by the public, but is not currently acknowledged in government social policy. The current evidence on the benefits of assistance dogs is limited by the type and scale of current research. This article highlights the need for independent funding for high quality research to enable social care and policy makers to make evidence-based decisions on the value of assistance dogs to people with disabilities

Transformations for climate change mitigation: A systematic review of terminology, concepts, and characteristics

Deep, broad, and rapid society-wide changes are urgently required to limit global temperature rise in line with the goals of the Paris Agreement. Since 2005, academics and policy makers have increasingly referred to such changes as transformations. This recent uptake and rapid diffusion of transformation-related concepts in research on climate change mitigation calls for a systematic and up-to-date analysis. In this article, we address this gap by undertaking a systematic review of articles that use transformation-related terms in the social science literature on climate change mitigation. Drawing on a corpus of 198 articles identified from Scopus, we find a diverse, fragmented research field that strongly focuses on the national, city, and international levels, the energy sector, and high-income countries. Although the use of transformation terminology has increased rapidly, there are few shared definitions, which arguably constitutes a serious challenge to scholarship and evidence-based policy making. To facilitate a more cumulative and impactful approach to research, we propose transformational climate change mitigation as a new umbrella term for the varied mitigation-related societal transformations required to meet the goals of the Paris Agreement. We conclude by identifying priorities for future research

Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach

BACKGROUND: Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds, and leads to short-term morbidity and longer-term metabolic programming in mother and offspring. We sought to understand the multiple influences on behaviour (hence risks to metabolic health) of South Asian mothers and their unborn child, theorise how these influences interact and build over time, and inform the design of culturally congruent, multi-level interventions. METHODS: Our sample for this qualitative study was 45 women of Bangladeshi, Indian, Sri Lankan, or Pakistani origin aged 21-45 years with a history of diabetes in pregnancy, recruited from diabetes and antenatal services in two deprived London boroughs. Overall, 17 women shared their experiences of diabetes, pregnancy, and health services in group discussions and 28 women gave individual narrative interviews, facilitated by multilingual researchers, audiotaped, translated, and transcribed. Data were analysed using the constant comparative method, drawing on sociological and narrative theories. RESULTS: Key storylines (over-arching narratives) recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control, and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother's strength, and that eating would be strength-giving for mother and fetus. These short-term storylines were nested within medium-term storylines about family life, especially the cultural, practical, and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare, and within longer-term storylines about genetic, cultural, and material heritage - including migration, acculturation, and family memories of food insecurity. While peer advice was familiar, meaningful, and morally resonant, health education advice from clinicians was usually unfamiliar and devoid of cultural meaning. CONCLUSIONS: 'Behaviour change' interventions aimed at preventing and managing diabetes in South Asian women before and during pregnancy are likely to be ineffective if delivered in a socio-cultural vacuum. Individual education should be supplemented with community-level interventions to address the socio-material constraints and cultural frames within which behavioural 'choices' are made

Exploring support for shale gas extraction in the United Kingdom

The development of shale gas in the United Kingdom (UK) using hydraulic fracturing, more commonly known as ‘fracking’, remains in its infancy. Yet understanding public attitudes for this fledgling industry is important for future policy considerations, decision-making and for industry stakeholders. This study uses data collected from the University of Nottingham UK nationwide online survey (n=3,823) conducted in September 2014, to consider ten hypothesises about the UK public’s attitudes towards shale gas. From the survey data we can see that 43.11% of respondents support shale gas extraction in the UK. Furthermore, our results show that women, class DE respondents, non-Conservative party supporters, and respondents who positively associate shale gas with water contamination or earthquakes are less likely to support the extraction of shale gas in the UK. We also discuss potential policy implications for the UK government arising from these findings

Factors influencing upcycling for UK makers

Changing consumer behaviour can reduce environmental impacts. Upcycling is one of the understudied yet promising, environmentally sustainable behaviours that has the potential to contribute to the reduction of waste and greenhouse gas emissions. This paper addresses this knowledge gap by exploring factors influencing upcycling for UK makers. The study employed a survey based on Triandis’s theory of interpersonal behaviour and Ajzen’s theory of planned behaviour. The survey results revealed key determinants of upcycling as attitude, intention, and subjective norm, and demographic characteristics of people who are more likely to upcycle frequently as females aged 30+ working in art and design. The paper further discusses the theoretical and practical implications of the study