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Dutton hints he’ll sack 36,000 public servants. Voters deserve to know what services will be affected
No full textThe relationship between radiological OA severity or body weight and outcomes following a structured education and exercise therapy program (GLA:D®) for people with knee osteoarthritis
Get PDFBackgroundClinicians may presume people with higher bodyweight or greater OA severity do not respond to exercise therapy for knee osteoarthritis (OA), but few studies have examined this.ObjectiveTo examine the relationship between radiographical OA severity or bodyweight and pain and functional outcomes following a structured education and exercise therapy program (Good Life with OsteoArthritis from Denmark: GLA:D®).Methods33 participants with knee OA were assessed at baseline and week 8 following GLA:D®. Outcomes were pain (Visual analogue scale (VAS) 0–100), Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12 total), 40 m-fast-paced walk and 30-s chair stand. Multilevel models were used to define the severity of OA in medial, lateral and patellofemoral compartments using the Kellgren-Lawrence (KL) system and to examine the relationship between compartment severity, bodyweight and outcomes.ResultsNo meaningful relationships between bodyweight and response to GLA:D® were found for any outcome measures. Greater medial OA compartment severity was related to less improvement in pain, KOOS-12 and chair stand repetitions. However, all levels of lateral compartment severity had similar improvements, and greater patellofemoral compartment severity was related to more improvement for KOOS-12 and pain.ConclusionBodyweight may have little influence on a person's response to a structured education and exercise therapy program. While people with greater medial compartment severity were less likely to improve following the program, OA severity in the PF and lateral compartments was not a barrier to improvement
Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050:a forecasting study for the Global Burden of Disease Study 2021
Get PDFBackground: Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions. Methods: Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5–14 years, typically in school and cared for by child health services) and older adolescents (aged 15–24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990–2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage. Findings: Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6–96·6) individuals aged 5–14 years and 80·6 million (78·2–83·3) aged 15–24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15–24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5–14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7–17·2) of those aged 5–14 years are forecasted to have obesity by 2050 (186 million [141–221]), compared with 14·2% (11·4–15·7) of those aged 15–24 years (175 million [136–203]). We forecasted that by 2050, there will be more young males (aged 5–14 years) living with obesity (16·5% [13·3–18·3]) than overweight (12·9% [12·2–13·6]); while for females (aged 5–24 years) and older males (aged 15–24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041–50: children and adolescents (males and females aged 5–24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5–14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5–14 years in Australasia; females aged 15–24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15–24 years in high-income North America. Interpretation: Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis. Funding: Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council.</p
Adaptive leadership of schools in Australia during the Covid-19 pandemic:lessons for future crises
No full textThis research reports the findings of a qualitative study conducted in the Australian Capital Territory (ACT) in 2022, which examined school leadership experiences in relation to crisis leadership during the Covid-19 pandemic through the prism of an adaptive leadership model. Interviews with leaders, including school principals, assistant principals, school board members, and education administrators, were thematically analysed, resulting in four key areas leaders reflected on which were related to adaptive leadership. These were the ability to change and adapt; the important role of communication; the focus on well-being; and productive collaborations. The findings showed how school leaders and education administrators interacting in their different roles and levels achieved effective collective action in responding to crisis with a heightened awareness of the wellbeing of the school community. The need for reflection and understanding of what occurred during this period is important to understand how leaders, including education administrators, adapted their leadership to meet the collective purpose of steering school communities through the chronic (ongoing) crisis. An adaptive leadership lens was used to explore the combined perspectives of different tiers of school leaders, which can provide useful insights for other chronic crisis situations, such as the widespread, ongoing teacher shortage
National Development Planning and Sustainability: The Case of Bhutan
No full textBhutan is a developmental success story that since the 1960s has consistently used five-year national development plans to make substantial socio-economic progress and promote sustainability. Many other developing countries had abandoned medium-term national planning by the 1980s, but Bhutan continued using these instruments as the principal mechanisms for developing the country and making substantial welfare gains for its population while attending to the sustainability of its development path and environment. Poverty has been greatly reduced, incomes have grown in real terms, life expectancy has markedly increased, there has been enormous growth in the provision of education and the country has become a world leader in environmental protection with 71% of Bhutan still under forest, making it the first carbon negative country in the world. The reasons for Bhutan’s success include always working within the capabilities of government, economy, and society; a demonstrated capacity to reorient development strategies with new plans; a stable political environment; good governance; the gradual inclusion of multiple stakeholders into the development process; a strong supportive relationship with neighbouring India; and the wise use of income from hydropower to fund development. Though there have been disruptions, mistakes, and failures in planning in Bhutan, the general trajectory of solid progress and continued attention to sustainability has been maintained; however, there are considerable challenges ahead for the ambitious Thirteenth Five-Year Plan (2024–2029). To investigate the Bhutanese experience, this article adopts a qualitative case study approach
Developing the Workplace Learning Social System:considerations for genomics implementation and workforce preparedness
No full textInnovations, such as genomics, are expected to transform the practice of the healthcare workforce. Workplace learning is an established and fundamental component of healthcare workforce training. We propose that it can be leveraged to facilitate workforce preparedness to adopt innovations relevant to practice. To explore this, this study aimed to develop a workplace learning framework premised on primary literature. Four databases were systematically searched to identify and synthesize contemporary research articles investigating doctors’ workplace learning, with an additional focus on genetics/genomics. From the articles included, factors influencing workplace learning were extracted. Informed by structuration and workplace learning theories, thematic analysis was conducted on these factors to generate the framework. Despite the lack of articles on doctors’ genetics/genomics workplace learning, 50 articles on doctors’ workplace learning were included. Extracted influencing factors were synthesized into five major domains, across three social system levels and the agentic learner, to generate the Workplace Learning Social System framework. Innovations in healthcare require its workforce to change work practices. The Workplace Learning Social System framework holistically conceptualizes workplace learning based on contemporary literature. It provides pragmatic insights to inform workforce development when implementing innovations as part of system-wide change.</p
Transformative change in a nexus world:product and process in the eleventh plenary of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES-11)
Get PDFThe eleventh session of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES-11) was held in Windhoek, Namibia, in December 2024. Approval of two assessments were the highlights of this plenary: the thematic assessment of the interlinkages among biodiversity, water, food and health - the so-called Nexus Assessment, and the thematic assessment of the underlying causes of biodiversity loss, determinants of transformative change and options for achieving the 2050 vision for biodiversity – the so-called Transformative Change Assessment. Yet the negotiations on the summaries for policymakers for those two assessments were marked more by national interests than by science. The authors were frequently challenged to justify evidence expressed in plain English, and the three years of work with its original scientific language was weakened by bureaucratically-driven wordsmithing. The assessments were finally approved with a range of response options and ways forward. Both assessments stress urgency and are policy-ready to be taken up by governments for implementation globally. IPBES continues ringing the scientific alarm bell, and science hopes that bell is heard.</p
Asthma medication usage after environmental exposure to wildfire smoke:A systematic review
Get PDFAsthma is a chronic respiratory condition exacerbated by exposure to particulate air pollution. Smoke from landscape fires has been associated with increased mortality, asthma-related admissions to emergency and other hospital departments, and uptake in primary care services. With climate change and more frequent landscape fires, healthcare systems must prepare for disaster, including surges in asthma medication demand. Past reviews have not resolved the direction and magnitude of the association between PM 2.5 exposure during landscape fires and asthma medication use. The aim of this review was to investigate the relationship between exposure to landscape fire smoke and the use of asthma medications. We conducted a systematic review of PubMed, Scopus, and Web of Science, identifying peer-reviewed articles that examined asthma medication usage following environmental exposure to landscape fire smoke. After a full-text review, we identified twelve articles, three from Canada, three from the USA and six from Australia, with five being retrospective cohort studies. Despite differences in study design, outcome and exposure assessment, the included studies reported a consistent increase in asthma medication use after exposure to wildfires. There is consistent evidence that exposure to wildfire smoke is associated with an increase in the use of reliever medications, particularly salbutamol. Increases in other asthma management medications were also consistently identified. Increases in demand for asthma medications after exposure to wildfire smoke highlight the urgent need to address the growing frequency and intensity of wildfires driven by climate change. </p
Deliberative reason and the effect of minipublic configurations
Get PDFAbstractIn exploring deliberative dynamics within mini-publics, it has been observed that initial group-building activities play a crucial role in enhancing deliberative reasoning. However, the influence of liberal democratic practices such as voting mechanisms and the inclusion of strategic or representative stakeholders, on deliberative processes is not well understood. This study undertakes a comparative configurational meta-analysis (CCMA) of 22 minipublics to investigate how these liberal democratic elements influence deliberative reasoning. Results indicate that participants’ deliberative reasoning is significantly enhanced in contexts where initial group activities are coupled with prolonged periods of deliberation and where voting is minimised or absent. In contrast, the presence of voting mechanisms, strategic stakeholder involvement, and a high impact of minipublics on decision-making processes are associated with weaker, negative, or stable participant deliberative reasoning. These findings contribute to the broader discourse on the integration of deliberative and non-deliberative components within minipublics, highlighting the potential negative impact of strategic behaviour on the quality of deliberation
Co-creating a research-based e-storybook for children coping with parental moral injury:insights from affected communities and partners
No full textThis study provided an account of the affected community and partner (stakeholders) input into the interdisciplinary co-creation process and preliminary testing of the suitability of a research-based e-storybook for children coping with parental moral injury. Children whose parents have trauma-related mental health difficulties, including moral injury, tend to misunderstand their parent’s responses and behaviours. To date, there have been no research-based narrative resources to support these children. Our interdisciplinary, international team of researchers, clinicians, and those with lived experience co-created a bibliotherapy storybook using moral injury narratives. Using a mixed methods approach, a cross-sectional online survey of key affected communities and partners was conducted to explore the resources’ suitability. Preliminary findings suggest overall suitability and that the e-storybook’s narratives acted as a springboard to conversations about what was happening in their families. Thus, the co-creation process is an effective approach to developing targeted supports for children coping with parental moral injury.</p