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‘Don’t forget the children’: a qualitative study when a parent is at end of life from cancer
No full textPurpose
Preparation for end of life is one of the greatest challenges faced by parents with cancer who have dependent children (
Methods
This is an interpretive qualitative study, using 79 semi-structured interviews with parents at end of life (n3), bereaved parents (n21), health and social care professionals (HSCPs) (n32) and funeral directors (n23). Data were analysed thematically and triangulated.
Results
Parents are central to preparing their children for the death of a parent. Striving for everyday ordinariness, maximising social networks, maintaining hope and making preparations for the future are helpful for families when a parent is at end of life. Most HSCPs were unaware of the challenges faced by parents at end of life, and psychosocial support was often left outside the caring realm. As a result, funeral directors noted complexities faced by the families after the death. Results are discussed under four themes: (1) communication with the children as a process, (2) coping throughout the unfolding end of life experience, (3) tension and complexities at end of life and (4) preparing for the future.
Conclusions
Parents should be reassured that by involving the children early in the end of life experience when the ill-parent is ‘well enough’ to parent enables them to be actively involved in supporting their child through one of the greatest life changing event. A number of recommendations are discussed for professionals
Who wants technocrats? A comparative study of citizen attitudes in nine young and consolidated democracies
No full textTechnocratic cabinets and expert, non-political ministers appointed in otherwise partisan cabinets have become a common reality in recent decades in young and older democracies, but we know little about how citizens see this change and what values, perceptions and experiences drive their attitudes towards technocratic government. The article explores the latter topic by drawing on recent comparative survey data from nine countries, both young and consolidated democracies from Europe and Latin America. Two individual-level characteristics trigger particularly strong support for the replacement of politicians with experts: low political efficacy and authoritarian values. They are complemented by a third, somewhat weaker factor: corruption perception. At the macro level, technocracy appeals to citizens of countries where the quality of democracy is deficient and where technocratic cabinets are a part of historical legacy. Surprisingly, civic activism and, partially, satisfaction with democracy enhance technocratic orientation, indicating such attitudes are not expressions of alienation or depoliticisation
Seascape ecology: identifying research priorities for an emerging ocean sustainability science
No full textSeascape ecology, the marine-centric counterpart to landscape ecology, is rapidly emerging as an interdisciplinary and spatially explicit ecological science with relevance to marine management, biodiversity conservation, and restoration. While important progress in this field has been made in the past decade, there has been no coherent prioritisation of key research questions to help set the future research agenda for seascape ecology. We used a 2-stage modified Delphi method to solicit applied research questions from academic experts in seascape ecology and then asked respondents to identify priority questions across 9 interrelated research themes using 2 rounds of selection. We also invited senior management/conservation practitioners to prioritise the same research questions. Analyses highlighted congruence and discrepancies in perceived priorities for applied research. Themes related to both ecological concepts and management practice, and those identified as priorities include seascape change, seascape connectivity, spatial and temporal scale, ecosystem-based management, and emerging technologies and metrics. Highest-priority questions (upper tercile) received 50% agreement between respondent groups, and lowest priorities (lower tercile) received 58% agreement. Across all 3 priority tiers, 36 of the 55 questions were within a ±10% band of agreement. We present the most important applied research questions as determined by the proportion of votes received. For each theme, we provide a synthesis of the research challenges and the potential role of seascape ecology. These priority questions and themes serve as a roadmap for advancing applied seascape ecology during, and beyond, the UN Decade of Ocean Science for Sustainable Development (2021-2030)
Writing units or decades first in two digit numbers dictation tasks: the case of Arabic - an inverted language
No full textThis study investigated the effect of educational level and of the syntactic representation of numbers in Arabic on the task of transcoding two-digit numbers from dictation. The participants were primary, junior-high, and high school pupils and higher education students. All spoke Arabic as a mother tongue. They performed a transcoding task, namely writing two-digit numbers from dictation. Units first\decades first writing patterns were collected depending on the differential syntactic structures of the two-digit number dictated (decades first: whole tens; units first: teen numbers; identical units and decades, remaining two-digit numbers). The findings reveal that in general, Arabic speakers adopt a decades-first writing pattern for two-digit numbers, especially when it is consistent with the syntactic structure of two-digit numbers, as in whole-tens numbers. This decade-first writing pattern is more evident and consistent in junior-high school, high school, and higher education than in primary school due to the improvement in mathematical skills and second and third languages. However, this pattern is modulated by the syntactic complexity of the unit–decade structure. This complexity is more pronounced in two-digit numbers whose processing is more dependent on numerical syntax. Thus, whole-tens numbers, teen numbers, and identical-decade–unit numbers are less complex than the remaining two-digit numbers
“SAH-RISK”: Risk factors for subarachnoid haemorrhage (SAH) - a descriptive and comparative study using electronic health records
No full textThe incidence of SAH is 7.9/100 000 person-years, with average age of onset of 62 (1). Non-traumatic subarachnoid haemorrhage (SAH) is most commonly caused by rupture of a weakness of an intra-cranial blood vessel (aneurysm). Although it represents only 5% of all strokes, SAH accounts for a similar number of years of life lost as the more common types of stroke (2-4). Despite improvements in clinical management of patients, outcomes after SAH remain poor, with an estimated 26% mortality rate and only 55% of patients regaining independent function (4).
Knowledge of modifiable risk factors for SAH is important in terms of prevention. Prospective population-based studies suggest that women have a 1.24 times greater risk of SAH than men. This becomes apparent after 50 years of age, and increases with each decade (5). An explanation for this observation is lacking, however. Loss of the protective effects of oestrogen in the post-menopausal state has been proposed, but studies comparing hormone replacement therapy (HRT) exposure vs. no HRT exposure on SAH incidence draw conflicting conclusions (6, 7).
Hypertension is an established modifiable risk factor for SAH, approximately doubling the risk of SAH (8, 9). A rise of 10mmHg in systolic blood pressure increases risk of SAH by 21% (10). A recent meta-analysis demonstrates a global decline in blood pressure which parallels a decrease in the global incidence of SAH (1) - highlighting the importance of primary prevention.
Whilst calcium channel blockers are routinely used to prevent secondary ischaemia following SAH, there is no evidence to support the preferential use of specific anti-hypertensives in patients at risk. There is some evidence that certain classes of antihypertensive may offer greater protection against stroke compared to other antihypertensives. One meta-analysis found that calcium channel blockers (CCBs) were associated with a reduced risk ratio (RR) of stroke incidence, compared to other antihypertensive classes (RR 0.83, 95% confidence interval 0.79-0.89)(11). In addition, angiotensin 2 inhibitors (ARBs) may reduce stroke risk compared to angiotensin-converting enzyme inhibitors (ACEis)(12), but the literature is inconsistent (11, 13). These findings are often based on meta-analyses of randomised controlled trials that recorded stroke as a secondary outcome – often not specifying if the stroke was haemorrhagic or ischaemic.
This protocol describes: 1) a descriptive study of the antecedent demographics and characteristics of SAH patients; 2) a comparative study investigating sex-differences and antihypertensive use on the risk of SAH
Rethinking reconstruction: Ethical standards and practice guidelines as a prerequisite to clitoral reconstruction following female genital mutilation/cutting
No full textWilson and Zaki describe a “Novel Clitoral Reconstruction and Coverage With Sensate Labial Flaps” as a “potential remedy” for women who have undergone female genital mutilation/cutting (FGM/C).1 We would like to discuss some scientific and ethical issues in relation to clitoral reconstruction (CR) surgery, touching on sociocultural, political, interpersonal, and psychological factors involved in promoting psychosexual health of women and girls with FGM/C
The epidemiology of atopic dermatitis in children and adults in the UK: a population-based cohort study using primary care data
No full textThe association between daily total physical activity and risk of cardiovascular disease among hypertensive patients: a 10-year prospective cohort study in China
No full textBackground
The effect of high levels of physical activity and relationship between daily total physical activity and the risk of cardiovascular disease (CVD) among hypertensive people were not clear. This study aimed to explore the optimum level of physical activity for CVD prevention.
Methods
Data used in the present study was derived from the sub-study of China Kadoorie Biobank study (CKB) in Jiangsu province of China. The CKB was a prospective cohort study established during 2004–2008. At baseline, 53,259 participants aged 35–74 years were recruited for the CKB Jiangsu sub-study conducted in Wuzhong district of Suzhou City. Among those 53,259 participants, the 20,179 hypertensive individuals were our study population. The outcome events were cardiovascular diseases (CVDs), while the independent variable was total daily physical activity. The Cox proportional hazard models were introduced to investigate the association between total physical activity and CVDs, reporting as hazard ratios (HR) and 95% confidence intervals (CIs).
Results
During a 10.1-year follow-up, 2419 CVD cases were identified. After adjustment for potential confounding factors, compared with participants at the lowest level of daily total physical activity, the hazard ratios for CVDs were 0.87 (95%CI: 0.79–0.97), 0.73 (95%CI: 0.65–0.83) and 0.75 (95%CI: 0.65–0.85) for participants within 2, 3 and 4 quartiles of physical activity. Such a negative association between total physical activity and CVDs were also observed among participants by gender and age-group, but within patients with stage 1 hypertension only. Moreover, the association of physical activity with CVDs was U-shape and the lowest HR (0.63, 95%CI: 0.54–0.74) was observed at 35.4 MET-h/d of total physical activity.
Conclusions
Total daily physical activity was negatively associated with CVDs among hypertensive adults in China, and this association was U-shape. It has some public health implications that community-based total physical activity intervention campaigns can be of help for CVDs prevention among hypertensive people in China
Metabolic activation and colitis pathogenesis is prevented by lymphotoxin β receptor expression in neutrophils
No full textInflammatory bowel disease is characterized by an exacerbated intestinal immune response, but the critical mechanisms regulating immune activation remain incompletely understood. We previously reported that the TNF-superfamily molecule TNFSF14 (LIGHT) is required for preventing severe disease in mouse models of colitis. In addition, deletion of lymphotoxin beta receptor (LTβR), which binds LIGHT, also led to aggravated colitis pathogenesis. Here, we aimed to determine the cell type(s) requiring LTβR and the mechanism critical for exacerbation of colitis. Specific deletion of LTβR in neutrophils (LTβRΔN), but not in several other cell types, was sufficient to induce aggravated colitis and colonic neutrophil accumulation. Mechanistically, RNA-Seq analysis revealed LIGHT-induced suppression of cellular metabolism, and mitochondrial function, that was dependent on LTβR. Functional studies confirmed increased mitochondrial mass and activity, associated with excessive mitochondrial ROS production and elevated glycolysis at steady-state and during colitis. Targeting these metabolic changes rescued exacerbated disease severity. Our results demonstrate that LIGHT signals to LTβR on neutrophils to suppress metabolic activation and thereby prevents exacerbated immune pathogenesis during colitis
Pharmacokinetic study of rectal artesunate in children with severe malaria in Africa
No full textWhen severe malaria is suspected in children, WHO recommends pre-treatment with a single rectal dose of artesunate before referral to an appropriate facility. This was an individually randomized, open-label, 2-arm, cross-over clinical trial in 83 Congolese children with severe falciparum malaria, to characterize the pharmacokinetics of rectal artesunate. At admission, children received a single dose of rectal artesunate (10 mg/kg) followed 12 hours later by intravenous artesunate (2.4 mg/kg) or the reverse order. All children also received standard doses of intravenous quinine. Artesunate and dihydroartemisinin were measured at eleven fixed intervals, following 0- and 12-hour drug administrations. Clinical, laboratory and parasitological parameters were measured. After rectal artesunate, artesunate and dihydroartemisinin showed large inter-individual variability (peak concentrations of dihydroartemisinin ranged from 5.63 to 8,090 nM). The majority of patients however, reached previously suggested in vivo IC50 (98.7%) and IC90 (92.5%) values of combined concentrations of artesunate and dihydroartemisinin between 15 to 30 minutes after drug administration. The median (IQR) time above IC50 and IC90 was 5.68 hours (2.90-6.08) and 2.74 hours (1.52-3.75), respectively. The absolute rectal bioavailability (IQR) was 25.6% (11.7-54.5) for artesunate and 19.8% (10.3-35.3) for dihydroartemisinin. The initial 12-hour parasite reduction ratio was comparable between rectal and intravenous artesunate: median (IQR) 84.3% (50.0-95.4) vs. 69.2% (45.7-93.6), respectively (p=0.49). Despite large inter-individual variability, rectal artesunate can initiate and sustain rapid parasiticidal activity in most children with severe falciparum malaria, while they are transferred to a facility where parenteral artesunate is available.(www.clinicalTrials.gov : NCT02492178