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Care Planning in Palliative and End-of-Life Care: A Systematic Review of Reviews. A white paper published by the Flinders Research Centre for Palliative Care, Death, and Dying
Get PDFCopyright Flinders UniversityAdvance care planning (ACP) plays a critical role in determining a person’s values, preferences, and beliefs prior to the point at which that individual may not be able to make or communicate his or her decisions. While ACP has become increasingly important in both policy and practice, a clear, shared understanding of what is meant by advance care planning remains elusive. The consequent variability in meaning and definitional ambiguity in relation to ACP can result in confusion around end-of-life practices and constrain the ability of policy makers, practitioners and others to determine the quality and effectiveness of ACP at different points and in different settings
Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis
No full textCopyright: © 2017 Gesesew et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Background
Discontinuation of antiretroviral therapy (ART) reduces the immunological benefit of treatment and increases complications related to human immune-deficiency virus (HIV). However, the risk factors for ART discontinuation are poorly understood in developing countries particularly in Ethiopia. This review aimed to assess the best available evidence regarding risk factors for ART discontinuation in Ethiopia.
Methods
Quantitative studies conducted in Ethiopia between 2002 and 2015 that evaluated factors associated with ART discontinuation were sought across six major databases. Only English language articles were included. This review considered studies that included the following outcome: ART treatment discontinuation, i.e. ‘lost to follow up’, ‘defaulting’ and ‘stopping medication’. Meta- analysis was performed with Mantel Haenszel method using Revman-5 software. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals at a p-value of <0.05.
Results
Nine (9) studies met the criteria of the search. Five (5) were retrospective studies, 3 were case control studies, and 1 was a prospective cohort study. The total sample size in the included studies was 62,156. Being rural dweller (OR = 2.1, 95%CI: 1.5–2.7, I2 = 60%), being illiterate (OR = 1.5, 95%CI: 1.1–2.1), being not married (OR = 1.4, 95%CI: 1.1–1.8), being alcohol drinker (OR = 2.9, 95%CI: 1.9–4.4, I2 = 39%), being tobacco smoker (OR = 2.6, 95%CI: 1.6–4.3, I2 = 74%), having mental illness (OR = 2.7, 95%CI: 1.6–4.6, I2 = 0%) and being bed ridden functional status (OR = 2.3, 95%CI: 1.5–3.4, I2 = 37%) were risk factors for ART discontinuation. Whereas, having HIV positive partner (OR = 0.4, 95%CI: 0.3–0.6, I2 = 69%) and being co-infected with Tb/HIV (OR = 0.6, 95%CI: 0.4–0.9, I2 = 0%) were protective factors.
Conclusion
Demographic, behavioral and clinical factors influenced ART treatment discontinuation. Hence, we recommend strengthening decentralization of HIV care services in remote areas, strengthening of ART task shifting, application of seek-test-treat-succeed model, and integration of smoking cession strategies and mental health care into the routine HIV care program
War, Violence and Rabindranath Tagore’s Quest for World Peace
Get PDFRabindranath Tagore (1861-1941), India’s messianic poet and Asia’s first Nobel Laureate (1913), promulgated a vision of peace through the cultivation of the ideologies of Ahimsa, or non-violence, which he derived from the Bhagavad Gita and Advita, or one-identity of the universe, which he derived from the Upanishads. This paper investigates how Tagore formulated this vision of peace against a backdrop of and as an antidote to the reckless “jihadism” (both religious and secular) and “war-madness” of the twentieth century, which witnessed the two World Wars as well as an on-going violence in different forms, effectively turning the world into a “tower of skulls.” He attributed this “devil dance of destruction” to three intersecting forces: the unmediated materialism of modern society; belligerent nationalism which often led to nationalist selfishness, chauvinism and self- aggrandisement; and the machinery of organised religion which, he said, “obstructs the free flow of inner life of the people and waylays and exploits it for the augmentation of its own power.” His response to it was the creation of a global human community, or a “grand harmony of all human races,” by shunning exclusivism and dogmatism of all forms, and through the fostering of awareness that human beings were not only material and rational as creatures but also moral and spiritual, sharing a dew-drop of God in every soul
Is there inequity amongst patients with acute coronary syndrome who are proficient and not proficient in English language in terms of their in-hospital care: Analysis of the SNAPSHOT ACS Study
Get PDFPosted in accordance with Publisher's copyright policy.Background: The provision of equitable acute coronary syndrome (ACS) care in Australia and New Zealand requires an understanding of the sources of variation in the provision of this care. Objective: The aim of this study was to compare the variation in care and outcomes between ACS patients with limited English proficiency (LEP) and English proficiency (EP) admitted to Australian and NZ hospitals. Methods: Data were collected from 4387 suspected/confirmed ACS patients from 286 hospitals between May 14 and 27, 2012, who were followed for 18 months. We compared hospital care and outcomes according to the proficiency of English using logistic regressions. Results: The 294 LEP patients were older (70.9 vs 66.3 years; P < .001) and had higher prevalenc
DNA methylation landscape of ocular tissue relative to matched peripheral blood
Get PDFThis work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/Epigenetic variation is implicated in a range of non-communicable diseases, including those of the eye. However, investigating the role of epigenetic variation in central tissues, such as eye or brain, remains problematic and peripheral tissues are often used as surrogates. In this study, matched human blood and eye tissue (n = 8) were obtained post-mortem and DNA methylation profiling performed on blood, neurosensory retina, retinal pigment epithelium (RPE)/choroid and optic nerve tissue using the Illumina Infinium HumanMethylation450 platform. Unsupervised clustering and principal components analysis revealed tissue of origin as the main driver of methylation variation. Despite this, there was a strong correlation of methylation profiles between tissues with >255,000 CpG sites found to have similar methylation levels. An additional ~16,000 show similarity across ocular tissues only. A small proportion of probes showing inter-individual variation in blood co-varied with eye tissues within individuals, however much of this variation may be genetically driven. An improved understanding of the epigenetic landscape of the eye will have important implications for understanding eye disease. Despite a generally high correlation irrespective of origin, tissue type is the major driver of methylation variation, with only limited covariation between blood and any specific ocular tissue
Perspectives from teachers and school leaders about long-term sustainability: A challenge for mental health promotion initiatives in educational settings
Get PDFCopyright ©2017 Sense Publishers Reproduced with permission of the publisher.The chapters in this book report research into a range of programs, across many countries, which have as their central concern the promotion of young people’s mental health and wellbeing. Funding has been directed towards introducing programs into primary schools, secondary schools and early childhood centres to develop young people’s mental health and wellbeing. These have included initiatives such as regular social and emotional education for all children, establishment of more effective and efficient referral pathways, and working collaboratively with parents/carers to support children and youth. During the initial phases of these initiatives, attention has been directed towards designing and testing good quality evidence-based programs. As efficacious programs have been rolled-out, attention has turned to achieving good quality implementation of program components. Now, as the field has matured, the key issue that emerges is the sustainability of programs once the initial implementation phases are over, and start-up resources (often substantial) are withdrawn. This issue of sustainability is of concern across international boundaries. In this chapter I report a research project that investigates teachers’ and school leaders’ perspectives about what has worked, and what has not worked, in achieving sustainability of wellbeing and mental health promotion initiatives in educational settings
Persistent LHPA Activation in German Individuals Raised in an Overprotective Parental Behavior
Get PDFOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.Parental upbringing may affect their offspring’s mental state across the entire lifespan. Overprotective parental child-rearing style may increase the disease burden in the offspring. Furthermore, this child-rearing style may also play a pathogenetic role by transmitting trauma- and stressor-related disorders (TSRD) across generations. Studies with animals have demonstrated that the mother’s immediate and expansive protection of the newborn decreases the limbic-hypothalamic-pituitary-adrenal (LHPA) axis activity in the offspring. However, few studies have investigated how stress impact humans raised in an overprotective manner. In a cross-sectional study with 40 healthy students recalling their overprotective upbringing, we show an increase in the dehydroepiandrostendione (DHEA) concentration and a reduction in the cortisol/DHEA-ratio in hair. Additionally, this child rearing style was associated with heightened indications of mental burden, depressiveness, and sense of coherence. Our results provide insight into the roots and consequences of psychological trauma across several generations. Further investigations focusing particularly on multigenerational transmission in extremely burdened families will augment our results
What is the difference between comprehensive and selective primary health care? Evidence from a fiveyear longitudinal realist case study in South Australia
Get PDFThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Background Since the WHO’s Alma Ata Declaration on Primary Health Care (PHC) there has been debate about the advisability of adopting comprehensive or selective PHC. Proponents of the latter argue that a more selective approach will enable interim gains while proponents of a comprehensive approach argue that it is needed to address the underlying causes of ill health and improve health outcomes sustainably.
Methods This research is based on four case studies of government-funded and run PHC services in Adelaide, South Australia. Program logic models were constructed from interviews and workshops. The initial model represented relatively comprehensive service provision in 2010. Subsequent interviews in 2013 permitted the construction of a selective PHC program logic model following a series of restructuring service changes.
Results Comparison of the PHC service program logic models before and after restructuring illustrates the changes to the operating context, underlying mechanisms, service qualities, activities, activity outcomes and anticipated community health outcomes. The PHC services moved from focusing on a range of community, group and individual clinical activities to a focus on the management of people with chronic disease. Under the more comprehensive model, activities were along a continuum of promotive, preventive, rehabilitative and curative. Under the selective model, the focus moved to rehabilitative and curative with very little other activities.
Conclusion The study demonstrates the difference between selective and comprehensive approaches to PHC in a rich country setting and is useful in informing debates on PHC especially in the context of the Sustainable Development Goals
Associations between quality of life and duration and frequency of physical activity and sedentary behaviour: Baseline findings from the WALK 2.0 randomised controlled trial
Get PDFThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.While physical and mental health benefits of regular physical activity are well known, increasing evidence suggests that limiting sedentary behaviour is also important for health. Evidence shows associations of physical activity and sedentary behaviour with health-related quality of life (HRQoL), however, these findings are based predominantly on duration measures of physical activity and sedentary behaviour (e.g., minutes/week), with less attention on frequency measures (e.g., number of bouts). We examined the association of HRQoL with physical activity and sedentary behaviour, using both continuous duration (average daily minutes) and frequency (average daily bouts≥10 min) measures. Baseline data from the WALK 2.0 trial were analysed. WALK 2.0 is a randomised controlled trial investigating the effects of Web 2.0 applications on engagement, retention, and subsequent physical activity change. Daily physical activity and sedentary behaviour (duration = average minutes, frequency = average number of bouts ≥10 minutes) were measured (ActiGraph GT3X) across one week, and HRQoL was assessed with the ‘general health’ subscale of the RAND 36-Item Health Survey. Structural equation modelling was used to evaluate associations. Participants (N = 504) were 50.8±13.1 (mean±SD) years old with a BMI of 29.3±6.0. The 465 participants with valid accelerometer data engaged in an average of 24.0±18.3 minutes and 0.64±0.74 bouts of moderate-vigorous physical activity per day, 535.2±83.8 minutes and 17.0±3.4 bouts of sedentary behaviour per day, and reported moderate-high general HRQoL (64.5±20.0). After adjusting for covariates, the duration measures of physical activity (path correlation = 0.294, p<0.05) and sedentary behaviour were related to general HRQoL (path coefficient = -0.217, p<0.05). The frequency measure of physical activity was also significant (path coefficient = -0.226, p<0.05) but the frequency of sedentary behaviour was not significantly associated with general HRQoL. Higher duration levels of physical activity in fewer bouts, and lower duration of sedentary behaviour are associated with better general HRQoL. Further prospective studies are required to investigate these associations in different population groups over time
On the Finitude of Time in Aristotle and Leibniz
Get PDFAll rights reserved © 2017, Modern Greek Studies Association of Australia and New Zealand. Reproduced with permission of the publisher.This paper considers an argument called here the Shift argument, which has the upshot,
it will be argued, that time cannot be infinite into the past but must have had a beginning
or first instant. The Shift argument can be found in Aristotle and many others. We
largely consider versions due to Aristotle and Leibniz, with the aim to draw essentially
opposite conclusions from Aristotle