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Scaling-Up an Early childhood Parenting Intervention by Integrating into Government Health Care Services in Rural Bangladesh: A Cluster-Randomised Controlled Trial
Get PDFAims: We evaluated the feasibility and effectiveness of utilising government health supervisors to train and supervise primary health care workers (HWs) in community clinics to deliver parenting sessions as part of their usual duties.Methods: We randomly allocated 16 unions in the Mymensing district of Bangladesh 1:1 to an intervention or control group. HWs in clinics in the eight intervention unions (n=59 health workers, n=24 clinics) were trained to deliver a group-based parenting intervention, with training and supervision provided by government supervisors. In each of the twenty-four intervention clinics, we recruited twenty-four mothers of children aged 6-24 months to participate in the parenting sessions (n=576 mother/child dyads). Mother/child dyads attended fortnightly parenting sessions at the clinic in groups of four-to-five participants for six months (13 sessions). We collected data on supervisor and HW compliance in implementing the intervention, mothers’ attendance and the observed quality of parenting sessions in all intervention clinics and HW burnout at endline in all clinics. We randomly selected 32 clinics (16 intervention, 16 control), and 384 mothers (192 intervention, 192 control) to participate in the evaluation on mother-reported home stimulation, measured at baseline and endline.Results: Supervisors and HWs attended all training, 46/59 health workers (78%) conducted the majority of parenting sessions, (only two HWs (3.4%) refused), and mothers’ attendance rate was 86%. However, supervision levels were low: only 32/57 (56.1%) of HWs received at least one supervisory visit. Intervention HWs delivered the parenting sessions with acceptable levels of quality on most items. The intervention significantly benefitted home stimulation (effect size=0.53SD, 95% confidence interval: 0.50, 1.56, p<0.001). HW burnout was low in both groups.Conclusion: Integration into the primary health care service is a promising approach for scaling early childhood development programmes in Bangladesh, although further research is required to identify feasible methods for facilitator supervision.<br/
Methodological considerations on estimating medication adherence from self-report, electronic monitoring, and electronic healthcare databases using the TEOS framework
Get PDFAimsMeasuring adherence to medication is complex due to the diversity of contexts in which medications are prescribed, dispensed and used. The Timelines-Events-Objectives-Sources (TEOS) framework outlined a process to operationalize adherence. We aimed to develop practical recommendations for quantification of medication adherence using self-report (SR), electronic monitoring (EM) and electronic healthcare databases (EHD) consistent with the TEOS framework for adherence operationalization.MethodsAn adherence methodology working group of the International Society for Medication Adherence (ESPACOMP) analysed implications of the process of medication adherence for all data sources and discussed considerations specific to SR, EM and EHD regarding the information available on the prescribing, dispensing, recommended and actual use timelines, the four events relevant for distinguishing the adherence phases, the study objectives commonly addressed with each type of data, and the potential sources of measurement error and quality criteria applicable.ResultsFour key implications for medication adherence measurement are common to all data sources: adherence is a comparison between two series of events (recommended and actual use); it refers to one or more specific medication(s); it applies to regular repeated events coinciding with known recommended dosing; and it requires separate measurement of the three adherence phases for a complete picture of patients' adherence. We propose recommendations deriving from these statements, and aspects to be considered in study design when measuring adherence with SR, EM and EHD using the TEOS framework.ConclusionThe quality of medication adherence estimates is the result of several design choices that may optimize the data available
Inequitable gains and losses from conservation in a global biodiversity hotspot
Get PDFA billion rural people live near tropical forests. Urban populations need them for water, energy and timber. Global society benefits from climate regulation and knowledge embodied in tropical biodiversity. Ecosystem service valuations can incentivise conservation, but determining costs and benefits across multiple stakeholders and interacting services is complex and rarely attempted. We report on a 10-year study, unprecedented in detail and scope, to determine the monetary value implications of conserving forests and woodlands in Tanzania’s Eastern Arc Mountains. Across plausible ranges of carbon price, agricultural yield and discount rate, conservationdelivers net global benefits (+US10.1B), while local-rural communities bear substantial net costs (-US72M); logging, fuelwood and management costs encourage depletion (-US$148M). Substantial global investment in disaggregating and mitigating local costs (e.g., through boosting smallholder yields) is essential to equitably balance conservation and development objectives
Standardisation: bolstering positive attitudes towards endangered language varieties? Evidence from implicit attitudes
Get PDFLanguage maintenance research generally argues that providing endangered varieties with a standard impact positively their vitality by e.g. increasing positive attitudes. This paper investigates whether different degrees of linguistic proximity between vernacular varieties and the standard may lead to different speakers’ attitudes towards the vernacular varieties. Following sociopsychological models of implicit automatic attitudes, e.g., dual attitude models, we hypothesised that varieties that have a more linguistically close standard would elicit more positive attitudes. We then used an online Auditory Implicit Association Test to investigate attitudes towards vernacular Moselle Franconian varieties in two speech communities, the Belgische Eifel in Belgium and the Éislek in Luxembourg. Moselle Franconian is considered generally vulnerable (UNESCO), and the two speech communities have opted for different methods of introducing a standard variety. While the speech community of Luxembourg created an ‘own’ linguistically close standard (Standard Luxembourgish), the Belgian speech community relies on a more linguistically distant standard, namely Standard German. Results show that linguistic distance between the standard and its vernaculars can impact on speakers’ attitudes. Our findings have important implications for the role of standardisation processes in language maintenance efforts
Why do they care? A qualitative systematic review and meta-synthesis of personal and relational motivations for providing informal care
Get PDFInformal caregiving is crucial to the sustainability of health and social care systems globally. With ageing populations and a rising prevalence of acute and chronic health conditions, the need for informal care is growing, making it important to understand what motivates individuals to care and to continue caring. This paper reports findings of a systematic review which examined determinants of motivations and willingness to provide informal care. A systematic search was conducted using six electronic databases and a wide range of additional sources. 105 qualitative studies published before August 2019 were included with 103 of them reporting on personal and relational motivations, and the contextual factors underpinning these. Grounded theory-based, thematic synthesis was applied to synthesise the literature. This meta-synthesis reports on findings from across the world spanning three decades, with data from over 2500 caregivers across a range of health conditions. This paper presents the relational, personal and contextual themes. It highlights the significance of reciprocity, affection, family values and caregiving obligations. Personal characteristics, finding meaning, illness perceptions, situational and temporal aspects of caregiving are also identified as important in shaping motivations and willingness to care and to continue caring. Implications for theory, research, policy and practice are discussed
The Moral and Emotional World of Police Informants
Get PDFThe global pattern of implementing proactive policing to address crime and insecurity continues to drive undercover techniques, including the deployment of police informants. Our aim in this article is to reflect upon research on informants policing, setting out a more comprehensive agenda that appreciates the moral significance and power dynamics at play. Our starting point is that this practice embodies immense moral and emotional tension, both for the police officer and the informant. However, these deeper aspects have been largely underestimated by scholars. Research can garner new insights by conceptualizing the tactic in terms of vulnerability, morality and emotional labour
Analysis of distributions reveals real differences on dichotic listening scores between left- and right-handers
Get PDFAbout 95% of right-handers and 70% of left-handers have a left-hemispheric specialization for language. Dichotic listening is often used as an indirect measure of this language asymmetry. However, while it reliably produces a right-ear advantage (REA), corresponding to the left-hemispheric specialization of language, it paradoxically often fails to obtain statistical evidence of mean differences between left- and right-handers. We hypothesized that non-normality of the underlying distributions might be in part responsible for the similarities in means. Here, we compare the mean ear advantage scores, and also contrast the distributions at multiple quantiles, in two large independent samples (Ns = 1,358 and 1,042) of right-handers and left-handers. Right-handers had an increased mean REA, and a larger proportion had an REA than in the left-handers. We also found that more left-handers are represented in the left-eared end of the distribution. These data suggest that subtle shifts in the distributions of DL scores for right- and left-handers may be at least partially responsible for the unreliability of significantly reduced mean REA in left-handers.</p
Biodegradable plastic mulch films increase yield and promote nitrogen use efficiency in organic horticulture.
Get PDFPlastic film mulches (PFM) are used extensively due to their ability to increase yield and suppress weed emergence. Their effects on plant-soil-microbial interactions, however, are less well understood. Organic systems rely on the supply of nutrients from organic sources (e.g., manures and fertility-building leys) and where poor N availability often limits yield. The issue is compounded by horticultural crops (e.g., lettuce) with a high N demand, but which are inefficient at recovering N from soil. The effect of PFM on the mineralisation of organic fertilisers and its interaction with other agronomic factors such as planting density is also less well-researched. We hypothesised that biodegradable PFM would be a useful tool to increase the efficiency of N management in organic horticulture by increasing the supply of available N leading to increased crop N uptake and crop yield, and simultaneously reducing N losses during the growing season. We conducted two field experiments under a temperate maritime climate with lettuces grown with either conventional (LDPE) PFM or a polylactic acid-based biodegradable PFM alongside un-mulched controls. The first experiment involved black or white coloured PFMs and two planting densities while the second experiment involved treatments with and without addition of poultry manure. Overall, yields were increased by 39% in both experiments with PFM, while soil mineral N concentrations were up to 5 times higher with PFM than without. Measurements of soil organic matter (SOM) turnover (Tea Bag Index) and soil CO2 efflux indicated a more rapid decay of SOM in the presence of the PFM. The use of PFM also promoted N use efficiency (NUE) by 300% in the presence of poultry manure. Denser planting with PFM resulted in proportionately higher yields. Higher yield and higher N concentrations (5-10%) in crop tissue in mulched plots resulted in higher total N uptake, however, total N uptake was low compared to soil concentrations: mulching with biodegradable PFM resulted in higher residual mineral N than un-mulched plots (77-147 mg kg-1 vs. 19 -70 mg kg-1). Our results are consistent with reduced N losses to the environment during the growing season and increased mineralisation under PFM. In conclusion, our findings support the adoption of PFM for organic horticulture and show that biodegradable PFM perform similarly to LDPE-based PFMs
