Strengths of Australian Aboriginal cultural practices in family life and child rearing

This paper explores some of the characteristics of traditional Aboriginal and Torres Strait Islander cultural practices that contribute to effective family functioning, and how these practices can have positive effects on children and communities. The approach is to gather the views of Aboriginal families and compare these perspectives with supporting evidence drawn from the literature. The findings suggest that, provided the necessary social conditions are in place, culture can be a protective force for children, families and communities. Key Messages Aboriginal kinship relations reflect a complex and dynamic system that is not captured by existing non- Indigenous definitions of family. Emerging evidence supports some of the strengths of traditional Aboriginal culture in family functioning and raising children, yet conventional academic wisdom can be incompatible with traditional Aboriginal knowledge systems. The strengths of Aboriginal cultural traditions, as they apply to family life and raising children, revolve around four interrelated themes, including: –    Theme 1: A collective community focus on child rearing helps children—The values of interdependence, group cohesion and community loyalty are key features of Aboriginal family and community life, where raising children is considered to be a shared responsibility of all community members. –    Theme 2: Children need the freedom to explore and experience the world—Aboriginal communities offer their children every opportunity to explore the world around them, to help them develop the necessary skills to successfully negotiate their pathways to adulthood. –    Theme 3: Elderly family members are important to family functioning—The elderly are highly respected for their contributions to family life in Aboriginal communities, particularly in helping children to understand the practical aspects of life and society. –    Theme 4: Spirituality helps families cope with challenges—Families and communities who engage in spiritual practices benefit from a greater sense of identity, and individuals are more likely to connect with, support and help protect one another

Genomic sequencing of SARS-CoV-2 in Rwanda reveals the importance of incoming travelers on lineage diversity

COVID-19 transmission rates are often linked to locally circulating strains of SARS-CoV-2. Here we describe 203 SARS-CoV-2 whole genome sequences analyzed from strains circulating in Rwanda from May 2020 to February 2021. In particular, we report a shift in variant distribution towards the emerging sub-lineage A.23.1 that is currently dominating. Furthermore, we report the detection of the first Rwandan cases of the B.1.1.7 and B.1.351 variants of concern among incoming travelers tested at Kigali International Airport. To assess the importance of viral introductions from neighboring countries and local transmission, we exploit available individual travel history metadata to inform spatio-temporal phylogeographic inference, enabling us to take into account infections from unsampled locations. We uncover an important role of neighboring countries in seeding introductions into Rwanda, including those from which no genomic sequences were available. Our results highlight the importance of systematic genomic surveillance and regional collaborations for a durable response towards combating COVID-19.info:eu-repo/semantics/publishe

Optimization of Metformin in the GRADE Cohort: Effect on Glycemia and Body Weight

ObjectiveWe evaluated the effect of optimizing metformin dosing on glycemia and body weight in type 2 diabetes.Research design and methodsThis was a prespecified analysis of 6,823 participants in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) taking metformin as the sole glucose-lowering drug who completed a 4- to 14-week (mean ± SD 7.9 ± 2.4) run-in in which metformin was adjusted to 2,000 mg/day or a maximally tolerated lower dose. Participants had type 2 diabetes for <10 years and an HbA1c ≥6.8% (51 mmol/mol) while taking ≥500 mg of metformin/day. Participants also received diet and exercise counseling. The primary outcome was the change in HbA1c during run-in.ResultsAdjusted for duration of run-in, the mean ± SD change in HbA1c was -0.65 ± 0.02% (-7.1 ± 0.2 mmol/mol) when the dose was increased by ≥1,000 mg/day, -0.48 ± 0.02% (-5.2 ± 0.2 mmol/mol) when the dose was unchanged, and -0.23 ± 0.07% (-2.5 ± 0.8 mmol/mol) when the dose was decreased (n = 2,169, 3,548, and 192, respectively). Higher HbA1c at entry predicted greater reduction in HbA1c (P < 0.001) in univariate and multivariate analyses. Weight loss adjusted for duration of run-in averaged 0.91 ± 0.05 kg in participants who increased metformin by ≥1,000 mg/day (n = 1,894).ConclusionsOptimizing metformin to 2,000 mg/day or a maximally tolerated lower dose combined with emphasis on medication adherence and lifestyle can improve glycemia in type 2 diabetes and HbA1c values ≥6.8% (51 mmol/mol). These findings may help guide efforts to optimize metformin therapy among persons with type 2 diabetes and suboptimal glycemic control