Concern Worldwide UK

Rapid growth and the concentration of hog production in North Carolina have raised concerns of a disproportionate impact of pollution and offensive odors on poor and nonwhite communities. We analyzed the location and characteristics of 2,514 intensive hog operations in relation to racial, economic, and water source characteristics of census block groups, neighborhoods with an average of approximately 500 households each. We used Poisson regression to evaluate the extent to which relationships between environmental justice variables and the number of hog operations persisted after consideration of population density. There are 18.9 times as many hog operations in the highest quintile of poverty as compared to the lowest; however, adjustment for population density reduces the excess to 7.2. Hog operations are approximately 5 times as common in the highest three quintiles of the percentage nonwhite population as compared to the lowest, adjusted for population density. The excess of hog operations is greatest in areas with both high poverty and high percentage nonwhites. Operations run by corporate integrators are more concentrated in poor and nonwhite areas than are operations run by independent growers. Most hog operations, which use waste pits that can contaminate groundwater, are located in areas with high dependence on well water for drinking. Disproportionate impacts of intensive hog production on people of color and on the poor may impede improvements in economic and environmental conditions that are needed to address public health in areas which have high disease rates and low access to medical care as compared to other areas of the state.

Objectives To give an overview on the use and prevalence of clinical pathways. Design Cross-sectional descriptive study. Study participants European Pathway Association (E-P-A) contact persons in 23 countries. Results Clinical pathways, also known as critical pathways or integrated care pathways, have been used in health care for 20 years. Although clinical pathways are well established, little information exists on their use and dissemination around the world. The E-P-A has performed their first international survey on the use and dissemination of clinical pathways in 23 countries. At present, pathways are used with a minority of patients, mainly in acute hospital trusts. Our survey showed that clinical pathways were predominantly viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Pathways were also used as a communication tool between professionals to manage and standardize outcome-oriented care. Conclusions There is a future for the use of clinical pathways, but there is a need for international benchmarking and knowledge sharing with regard to their development, implementation and evaluation.

BACKGROUND: Bipolar disorder is chronic and debilitating. Studies investigating resting-state functional connectivity in individuals with bipolar disorder may help to inform neurobiological models of illness. METHODS: We conducted a systematic review with the following goals: to summarize the literature on resting-state functional connectivity in bipolar disorder during clinical remission (euthymia) compared with healthy controls; to critically appraise the literature and research gaps; and to propose directions for future research. We searched PubMed/MEDLINE, Embase, PsycINFO, CINAHL and grey literature up to April 2017. RESULTS: Twenty-three studies were included. The most consistent finding was the absence of differences in resting-state functional connectivity of the default mode network (DMN), frontoparietal network (FPN) and salience network (SN) between people with bipolar disorder and controls, using independent component analysis. However, 2 studies in people with bipolar disorder who were positive for psychosis history reported DMN hypoconnectivity. Studies using seed-based analysis largely reported aberrant resting-state functional connectivity with the amygdala, ventrolateral prefrontal cortex, cingulate cortex and medial prefrontal cortex in people with bipolar disorder compared with controls. Few studies used regional homogeneity or amplitude of low-frequency fluctuations. LIMITATIONS: We found heterogeneity in the analysis methods used. CONCLUSION: Stability of the DMN, FPN and SN may reflect a state of remission. Further, DMN hypoconnectivity may reflect a positive history of psychosis in patients with bipolar disorder compared with controls, highlighting a potentially different neural phenotype of psychosis in people with bipolar disorder. Resting-state functional connectivity changes between the amygdala, prefrontal cortex and cingulate cortex may reflect a neural correlate of subthreshold symptoms experienced in bipolar disorder euthymia, the trait-based pathophysiology of bipolar disorder and/or a compensatory mechanism to maintain a state of euthymia.

Tourism as an industry is increasing rapidly in developing countries. Due to historical inequality in global trading relationships on the basis of ‘core–periphery’ dependency, globalisation and liberalised free trade, mainstream mass tourism reinforces the social and economic disadvantages of southern destinations. The ‘Fair Trade Movement’ has sought to redress unequal trading by promoting fair trade in commodities with small producers in the South, enabling them to take control over the production and marketing process and challenging the power of transnational corporations. This paper examines the feasibility of fair trade in tourism. It explores the obstacles and opportunities that might lead to establishing a definition of fair trade in tourism, incorporating criteria that would be workable and practical for both partners in the South and North. Copyright © 2000 John Wiley & Sons, Ltd.

BACKGROUND: Recommended immediate newborn care practices include thermal care (immediate drying and wrapping, skin-to-skin contact after delivery, delayed bathing), hygienic cord care and early initiation of breastfeeding. This paper systematically reviews quantitative and qualitative data from sub-Saharan Africa on the prevalence of key immediate newborn care practices and the factors that influence them. METHODS: Studies were identified by searching relevant databases and websites, contacting national and international academics and implementers and hand-searching reference lists of included articles. English-language published and unpublished literature reporting primary data from sub-Saharan Africa (published between January 2001 and May 2014) were included if it met the quality criteria. Quantitative prevalence data were extracted and summarized. Qualitative data were synthesized through thematic analysis, with deductive coding used to identify emergent themes within each care practice. A framework approach was used to identify prominent and divergent themes. RESULTS: Forty-two studies were included as well as DHS data - only available for early breastfeeding practices from 33 countries. Results found variation in the prevalence of immediate newborn care practices between countries, with the exception of skin-to-skin contact after delivery which was universally low. The importance of keeping newborn babies warm was well recognized, although thermal care practices were sub-optimal. Similar factors influenced practices across countries, including delayed drying and wrapping because the birth attendant focused on the mother; bathing newborns soon after delivery to remove the dirt and blood; negative beliefs about the vernix; applying substances to the cord to make it drop off quickly; and delayed breastfeeding because of a perception of a lack of milk or because the baby needs to sleep after delivery or does not showing signs of hunger. CONCLUSION: The majority of studies included in this review came from five countries (Ethiopia, Ghana, Malawi, Tanzania and Uganda). There is a need for more research from a wider geographical area, more research on newborn care practices at health facilities and standardization in measuring newborn care practices. The findings of this study could inform behaviour change interventions to improve the uptake of immediate newborn care practices.

BACKGROUND: A large number of randomised controlled trials in health settings have consistently reported positive effects of brief intervention in terms of reductions in alcohol use. However, although alcohol misuse is common amongst offenders, there is limited evidence of alcohol brief interventions in the criminal justice field. This factorial pragmatic cluster randomised controlled trial with Offender Managers (OMs) as the unit of randomisation will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in probation and different intensities of brief intervention to reduce excessive drinking in probation clients. METHODS AND DESIGN: Ninety-six OMs from 9 probation areas across 3 English regions (the North East Region (n = 4) and London and the South East Regions (n = 5)) will be recruited. OMs will be randomly allocated to one of three intervention conditions: a client information leaflet control condition (n = 32 OMs); 5-minute simple structured advice (n = 32 OMs) and 20-minute brief lifestyle counselling delivered by an Alcohol Health Worker (n = 32 OMs). Randomisation will be stratified by probation area. To test the relative effectiveness of different screening methods all OMs will be randomised to either the Modified Single Item Screening Questionnaire (M-SASQ) or the Fast Alcohol Screening Test (FAST). There will be a minimum of 480 clients recruited into the trial. There will be an intention to treat analysis of study outcomes at 6 and 12 months post intervention. Analysis will include client measures (screening result, weekly alcohol consumption, alcohol-related problems, re-offending, public service use and quality of life) and implementation measures from OMs (the extent of screening and brief intervention beyond the minimum recruitment threshold will provide data on acceptability and feasibility of different models of brief intervention). We will also examine the practitioner and organisational factors associated with successful implementation. DISCUSSION: The trial will evaluate the impact of screening and brief alcohol intervention in routine probation work and therefore its findings will be highly relevant to probation teams and thus the criminal justice system in the UK.Ethical approval was given by Northern & Yorkshire REC. TRIAL REGISTRATION NUMBER: ISRCTN 19160244.

This research examined differences between Britain and Italy in the proximity of older women (aged 60-74) to their children. We hypothesized that in Britain proximity is more likely to result from the needs of the older generation, whereas in Italy it is more likely to reflect a cultural preference. Employing data from the British Retirement Survey follow-up in 1994, and the 1995 Italian Indagine Multiscopo sulle Famiglie, we applied multinomial logit models to examine the correlates of proximity. Our findings showed that, in Britain, mothers' health had a greater impact on proximity than in Italy, suggesting that the needs of the older generation in Britain were important for determining proximity. An additional analysis showed that children's characteristics were also important in determining proximity in Italy, mainly because of delayed adult transitions. This supports the hypothesis that intergenerational proximity in Italy is more likely to be a response to the needs of children than of parents.

This article examines whether the psychological impact of different kinds of social supports varies according to who provides them. Data on 82 older adults' social relationships, measured as social provisions (Weiss, 1974), were used to evaluate whether the relationship between social provisions and emotional well-being varied when kin and, alternatively, nonkin, made the provisions. Findings showed that, although most social provisions were valuable regardless of their source, reassurance of worth was distinctly more beneficial when provided by nonkin than by kin, and reliable alliance, or instrumental assistance, was more strongly related to well-being when provided by kin than by nonkin. Analysis of social network structure showed that "multiplexity" was negatively related to well-being, and having duplicate providers for a given social provision was uniquely important in offsetting negative affect.

OBJECTIVES: We evaluated the implementation and effectiveness of adjunctive dexamethasone in adults with meningococcal meningitis. METHODS: We compared 2 Dutch prospective nationwide cohort studies on community-acquired meningococcal meningitis. A total of 258 patients with CSF culture-proven meningitis were enrolled between 1998 and 2002, before routine dexamethasone therapy was introduced, and 100 patients from March 2006 to January 2011, after guidelines recommended dexamethasone. RESULTS: Dexamethasone was administered in 43 of 258 (17%) patients in the 1998-2002 cohort and in 86 of 96 (90%) patients in the 2006-2011 cohort (p < 0.001), and was started with or before the first dose of antibiotics in 12 of 258 (5%) and 85 of 96 (89%) patients (p < 0.001). Rates of unfavorable outcome were similar between cohorts (12 of 100 [12%] vs 30 of 258 [12%]; p = 0.67), also after correction for meningococcal serogroup. The rates of hearing loss (3 of 96 [3%] vs 19 of 237 [8%]; p = 0.10) and death (4 of 100 [4%] vs 19 of 258 [7%]; p = 0.24) were lower in the 2006-2011 cohort, but this did not reach significance. The rate of arthritis was lower in patients treated with dexamethasone (32 of 258 [12%] vs 5 of 96 [5%], p = 0.046). Dexamethasone was not associated with adverse events. CONCLUSIONS: Adjunctive dexamethasone is widely prescribed for patients with meningococcal meningitis and is not associated with harm. The rate of arthritis has decreased after the implementation of dexamethasone. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that adjuvant dexamethasone in adults with meningococcal meningitis does not increase negative outcomes such as deafness, death, or negative Glasgow Outcome Scale measures.

OBJECTIVE: Research suggests that temporary abstinence from alcohol may convey physiological benefits and enhance well-being. The aim of this study was to address a lack of information about: (a) correlates of successful completion of a planned period of abstinence, and (b) how success or failure in planned abstinence affects subsequent alcohol consumption. METHOD: 857 British adults (249 men, 608 women) participating in the "Dry January" alcohol abstinence challenge completed a baseline questionnaire, a 1-month follow-up questionnaire, and a 6-month follow-up questionnaire. Key variables assessed at baseline included measures of alcohol consumption and drink refusal self-efficacy (DRSE). RESULTS: In bivariate analysis, success during Dry January was predicted by measures of more moderate alcohol consumption and greater social DRSE at baseline. Multivariate analyses revealed that success during Dry January was best predicted by a lower frequency of drunkenness in the month prior to Dry January. Structural equation modeling revealed that participation in Dry January was related to reductions in alcohol consumption and increases in DRSE among all respondents at 6-month follow-up, regardless of success, but indicated that these changes were more likely among people who successfully completed the challenge. CONCLUSIONS: The findings suggest that participation in abstinence challenges such as Dry January may be associated with changes toward healthier drinking and greater DRSE, and is unlikely to result in undesirable "rebound effects": very few people reported increased alcohol consumption following a period of voluntary abstinence.

In recent years, there has been a growth in academic interest in international retirement migration in Europe, particularly north-south retirement migration to destinations like Spain. In this paper we focus on those members of the British community who have lived in Spain for a considerable time and for whom familial, social and institutional ties with Britain are weak or disrupted. Age Concern España was established by members of the British community to provide information and services on healthcare, benefits and local services in Spain. Four indicative case studies of those requesting assistance and classified as being of ‘serious need’ are presented. They illustrate the ways in which happy and fulfilling lives in Spain were abruptly changed as the person's resources (bodily, economic, social and skills) for independent living diminished, and in which institutions and friendship networks played a key role in supporting life. The paper is the product of collaboration between researchers and practitioners in Spain and the UK, and brings together previous research with new qualitative case studies. Whilst policy-makers, practitioners and gerontologists have an increasing awareness of the needs of older migrants and the challenges they pose for public policy, particularly for health and social care systems in Spain, there have been little sustained analysis and cross-country debate.

BACKGROUND: The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is a relatively new measure and to date has been validated in a number of populations, including student, general and adolescent samples across the UK. There is increasing interest in measuring the mental well-being of users of secondary care mental health services and therefore it is apt to validate WEMWBS for this population. AIMS: To investigate the validity of WEMWBS in a secondary care mental health service user population. METHOD: Data was collected from two NHS Trusts and one charity. Analyses are based on 1180 completed WEMWBS. RESULTS: WEMWBS scores for this population are significantly lower than those in a general population (Mean 34.9, SD 13.8). Overall the data analyses supported the use of WEMWBS in this population sample. The Rasch analysis found that the majority of the items can be seen as measuring one dimension. The confirmatory factor analysis supports a one factor solution and thus, measures a single underlying concept. CONCLUSIONS: The findings from this study show WEMWBS to be a valid and reliable measure for this population sample.

Orang Asli are the indigenous minority peoples of peninsular Malaysia. Despite proactive socioeconomic development initiated by the Malaysian Government in upgrading the quality of life of the Orang Asli communities since 1978, they still remained poor with a current poverty rate of 76.9%. Poverty exacerbates the health problems faced by these communities which include malnourishment, high incidences of infectious diseases (eg. tuberculosis, leprosy, malaria) and the perpetual problem with intestinal parasitic infections. Studies reported that the mean infection rate of intestinal parasitic infections in Orang Asli communities has reduced from 91.1% in 1978, to 64.1% in the subsequent years. Although the results was encouraging, it has to be interpreted with caution because nearly 80% of studies carried out after 1978 still reported high prevalence (i.e. >50%) of soil-transmitted helminthiases (STH) among Orang Asli communities. Prior to 1978, hookworm infection is the most predominant STH but today, trichuriasis is the most common STH infections. The risk factors for intestinal parasitic infections remained unchanged and studies conducted in recent years suggested that severe STH infections contributed to malnutrition, iron deficiency anaemia and low serum retinol in Orang Asli communities. In addition, STH may also contribute to poor cognitive functions and learning ability. Improvements in socioeconomic status in Malaysia have shown positive impact on the reduction of intestinal parasitic infections in other communities however, this positive impact is less significant in the Orang Asli communities. In view of this, a national parasitic infections baseline data on morbidity and mortality in the 18 subgroups of Orang Asli, will assist in identifying intervention programmes required by these communities. It is hope that the adoption of strategies highlighted in the World Health Organisation- Healthy Village Initiatives (WHO-HVI) into Orang Asli communities will ensure the whole mechanism of delivery and empowerment by the government agencies become more efficient and productive in alleviating intestinal parasitic infections in these communities.

The aim of this study was to investigate the effect of victim resistance in attempted homicide. The study examined 93 cases of attempted homicide. Chi-square analysis revealed that certain behaviors, such as multiple acts of violence and methods of control, are more likely to occur if the victim resists. A multivariate analysis of crime-scene actions was carried out using Smallest Space Analysis. The plot showed three clusters of variables that reflected the offender's perception of the victim as an object, vehicle, or significant person. In the first of these roles, the offender was likely to escalate the level of violence; in the vehicle role, however, the offender employed physical controls and used single acts of violence. Finally, if the victim was personally significant to the offender, the latter was more likely to use verbal control strategies and knowledge of the victim. The implications of victim resistance in light of these role functions are discussed.

BACKGROUND: Supported self-management is a recommended intervention for chronic pain. Effective self-management should enable an individual to reduce the impact of pain on their everyday life. Clinical guidelines suggest primary care services have a role to play in supporting self-management of chronic pain. AIM: To examine the opinions of primary care healthcare professionals (HCPs) and people with chronic pain and their carers, in order to identify possible barriers to the facilitation and adoption of self-management. DESIGN AND SETTING: A qualitative study using focus groups in locations throughout Scotland. METHOD: Eighteen focus groups were held with patients and HCPs. Fifty-four patients, nine carers, and 38 HCPs attended the groups. RESULTS: Four categories of barriers were found. 1) Patient-HCP consultation: some patients felt a discussion about self-management came too late or not at all. Communication and building positive relations were sometimes challenging. 2) Patient experience: the emotional impact of pain was difficult and patients often felt unsupported by HCPs. 3) Limited treatment options: some participants felt there was a tendency for overmedicalisation. 4) Organisational constraints: short appointment times, long waiting lists, and a compartmentalised NHS created challenges. CONCLUSION: This study illustrates some of the barriers faced by HCPs and patients in the facilitation and adoption of self-management of chronic pain. If self-management is to be an important approach to chronic pain, primary care services need to be designed to address the barriers identified.

ABSTRACT The climate crisis and the credit crisis have made the political issues surrounding investment and finance more critical than ever before. Proposals for ‘Green New Deals’ and the like — aimed at tackling both global warming and global recession — are streaming forth worldwide. Yet many such proposals are incoherent in that they overlook the need for an immediate start to a programme of phasing out both fossil fuels and purported fossil fuel substitutes such as nuclear power and industrial‐scale agrofuels. They also tend to rely on Northern‐biased conceptions of technology transfer and intellectual property that the climate crisis has helped make obsolete. To overcome these problems, future climate movements will have to focus increasingly on the democratization of research, planning and finance.

BACKGROUND: There have been many randomized controlled trials of screening and brief alcohol intervention in primary care. Most trials have reported positive effects of brief intervention, in terms of reduced alcohol consumption in excessive drinkers. Despite this considerable evidence-base, key questions remain unanswered including: the applicability of the evidence to routine practice; the most efficient strategy for screening patients; and the required intensity of brief intervention in primary care. This pragmatic factorial trial, with cluster randomization of practices, will evaluate the effectiveness and cost-effectiveness of different models of screening to identify hazardous and harmful drinkers in primary care and different intensities of brief intervention to reduce excessive drinking in primary care patients. METHODS AND DESIGN: GPs and nurses from 24 practices across the North East (n=12), London and South East (n=12) of England will be recruited. Practices will be randomly allocated to one of three intervention conditions: a leaflet-only control group (n=8); brief structured advice (n=8); and brief lifestyle counselling (n=8). To test the relative effectiveness of different screening methods all practices will also be randomised to either a universal or targeted screening approach and to use either a modified single item (M-SASQ) or FAST screening tool. Screening randomisation will incorporate stratification by geographical area and intervention condition. During the intervention stage of the trial, practices in each of the three arms will recruit at least 31 hazardous or harmful drinkers who will receive a short baseline assessment followed by brief intervention. Thus there will be a minimum of 744 patients recruited into the trial. DISCUSSION: The trial will evaluate the impact of screening and brief alcohol intervention in routine practice; thus its findings will be highly relevant to clinicians working in primary care in the UK. There will be an intention to treat analysis of study outcomes at 6 and 12 months after intervention. Analyses will include patient measures (screening result, weekly alcohol consumption, alcohol-related problems, public service use and quality of life) and implementation measures from practice staff (the acceptability and feasibility of different models of brief intervention.) We will also examine organisational factors associated with successful implementation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN06145674.

The desert fog oasis ecosystem of Peru and Chile comprises numerous oases along 3000 km of the Pacific coastal belt, it hosts a highly endemic flora, providing vital ecosystem services and genetic resources. However, due to their marked seasonality and fog cover they are poorly mapped, greatly compromising their conservation. Here we redress this using 479 images from the MODIS (MOD13Q1 V6 product) data/algorithm for the period 2000–2020, permitting the mapping of ephemeral vegetation, herbaceous and woody fog oases vegetation. In addition, we examine the main drivers of productivity in this unique ecosystem using generalised linear models, assess human pressures, conservation efforts, and summarise present plant diversity knowledge. The resultant map (https://gistin.users.earthengine.app/view/fogoasis) extends existing mapped areas by more than four-fold to over 17,000 km2, revealing extensive little-known vegetation habitats with few or no collection records. Tillandsia (‘air plants’) fog oases were mapped manually due to poor spectral discrimination and were found to cover an area of approximately 1,900 km2 the majority of which is in Peru (96%). Fog oasis productivity is significantly related to aridity and distance to the coast, as well as elevation and slope angle. Most fog oases peak in productivity during August-September, although productivity is highly variable between August and December with different oases reacting to inter-annual and annual climate fluxes. Only 4% of fog oases are protected, most are threatened by mining, urban development, air pollution and off-road 4 × 4 driving. Urgent action is needed to protect these areas, which we estimate support around 1200 ecosystem-specific flowering plant species with approximately 30% endemism in Peru and 67% in Chile. By presenting a comprehensive map and catalogue of Peruvian and Chilean fog oases, we hope to catalyse increased conservation and research towards a better understanding of these exceptional ecosystems within South America.

Head louse infestations continue to be a concern of public health in most countries, including the most developed ones. The present recommendations are intended to inform and stress the role and impact of the different authorities, institutions, industry, and the public in the control of head lice in order to reduce the prevalence of this parasite. We encourage health authorities to pursue more effective methods to correctly identify such infestations, and evaluate existing and new pediculicides, medical devices, louse repellents, and louse- and nit-removal remedies. Pediculicides and medical devices must have verifiable claims in the instructions for use and should be tested periodically to document current levels of resistance by lice to the active ingredients and to the formulated products. Where the prevalence of lice is claimed to be epidemic, children should be periodically evaluated objectively to document the actual level of prevalence. Continuing education for health providers and the general population promises to correct misinformation regarding the biology, prevention, and management of lice. Parents should regularly inspect their children for head lice and treat as necessary. Health authorities are encouraged to eliminate policies and practices that rely upon school exclusion as a means to reduce incidence and prevalence, e.g., the 'no-nit' policy which lacks scientific justification, and are counterproductive to the health and welfare of children.

Estrogen is regulated through two intracellular receptors, estrogen receptor alpha and estrogen receptor beta, through a classic nuclear-initiated response. Recently, estrogen has also been shown to act more rapidly and it is proposed that these fast effects may be the consequence of membrane localized estrogen receptors that act through the second messengers. Although the identification of these receptors remains to be elucidated, the possible role that they play in female-specific mood disorders is of particular interest, especially in times of major hormonal fluctuation. The purpose of this mini-review is to outline the recent literature regarding the rapid effects of estrogen, to explore the intracellular signaling pathways that may be involved in this regulation as well as the connection between estrogen and serotonin neurotransmission and finally, to look into the antidepressant role that estrogen may have, with particular emphasis on female-specific mood disorders.