Treatment Outcomes for Toddlers with Behaviour Problems from Families in Poverty

Background. Relatively few treatment studies address mental health issues in very young children. This study examined the effectiveness of a treatment program for toddlers whose behavior problems were further complicated by living in poverty. Method. An empirically-validated treatment program was adapted for use in the homes of 102 toddlers for an average of 12 weekly sessions. Results. Significant improvements were found for the children’s behavior problems and their compliance to parent requests. Discussion. The inherent challenges in working with at-risk families and the challenges in delivering mental health services for very young children living in poverty are discussed

What sources of bereavement support are perceived helpful by bereaved people and why? Empirical evidence for the compassionate communities approach

YesAims: To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care. Design: A population-based cross-sectional investigation of bereavement experiences. Sources of support (informal, community and professional) were categorised according to the Public Health Model of Bereavement Support; most helpful reasons were categorised using the Social Provisions Scale, and least helpful were analysed using inductive content analysis. Setting and participants: Bereaved people were recruited from databases of funeral providers in Australia via an anonymous postal survey (2013–2014). Results: In total, 678 bereaved people responded to the survey. The most frequently used sources of support were in the informal category such as family, friends and funeral providers. While the professional category sources were the least used, they had the highest proportions of perceived unhelpfulness whereas the lowest proportions of unhelpfulness were in the informal category. The functional types of helpful support were Attachment, Reliable Alliance, Social Integration and Guidance. The five themes for least helpful support were: Insensitivity, Absence of Anticipated Support, Poor Advice, Lack of Empathy and Systemic Hindrance. Conclusion: A public health approach, as exemplified by compassionate communities policies and practices, should be adopted to support the majority of bereaved people as much of this support is already provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved. This study has provided further support for the need to strengthen the compassionate communities approach, not only for end of life care for dying patients but also along the continuum of bereavement support.Health Department of Western Australia

MicroRNA regulation of endothelial TREX1 reprograms the tumour microenvironment

Rather than targeting tumour cells directly, elements of the tumour microenvironment can be modulated to sensitize tumours to the effects of therapy. Here we report a unique mechanism by which ectopic microRNA-103 can manipulate tumour-associated endothelial cells to enhance tumour cell death. Using gain-and-loss of function approaches, we show that miR-103 exacerbates DNA damage and inhibits angiogenesis in vitro and in vivo. Local, systemic or vascular-targeted delivery of miR-103 in tumour-bearing mice decreased angiogenesis and tumour growth. Mechanistically, miR-103 regulation of its target gene TREX1 in endothelial cells governs the secretion of pro-inflammatory cytokines into the tumour microenvironment. Our data suggest that this inflammatory milieu may potentiate tumour cell death by supporting immune activation and inducing tumour expression of Fas and TRAIL receptors. Our findings reveal miR-mediated crosstalk between vasculature and tumour cells that can be exploited to improve the efficacy of chemotherapy and radiation.United States. National Institutes of Health (R00HL112962)United States. National Institutes of Health (R01 HL57900)Oregon Health & Science University. Knight Cancer Institute (2015-Dive-Knight-01

Governing precarious lives: Land grabs, geopolitics, and 'food security'

This paper has a two-part structure. The first part of the paper explores contemporary land grabs and shows how they both reflect and constitute a new neo-liberal governance structure over land and land-based resources. In this sense what is noteworthy about land grabs is their world-making capacity: the deals structure and make possible new relations of power in the global food economy. For this very reason it is crucial to understand how land grabs affect both the pace and direction of agrarian change. The second part of the paper examines the discursive strategies that align ‘food security’ concerns with land grabbing practices. Here I suggest that ‘food security’ supplies a moral sanction for land grabs. By mustering public empathy around a desire to ‘feed the future’, food security discourse – to borrow an idea from Fassin (2012) – converts a relationship of dominance (the governance of precarious lives) into a relationship of assistance (the provision of a remedy).This is the accepted manuscript. The final version is available from Wiley at http://dx.doi.org/10.1111/geoj.1206

Moral competence in nursing practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88187/1/ketefian-moral_competence_nursing_practice.pd

A phenomenological investigation of licensed professional counselors' perspectives of clinical intuition

The purpose of this study was to investigate the essence of the experience of clinical intuition through the perspective of licensed professional counselors. Despite the attention that intuition had been given in other professional fields, a lack of research that was specific to the counseling profession existed on this topic. This dearth of literature existed despite the apparent connection between counselor development and intuition. For instance, models of counselor development depicted how counselors increase their awareness of themselves, their clients, and the counseling relationship as they gain more clinical experience, while theories on the nature of intuition suggested that experience and awareness produce intuitive knowledge. In spite of that association, clinical intuition in the field of licensed professional counselors had not been examined. Given that counselors’ clinical intuition was little understood, a phenomenological design was selected for this investigation. This type of qualitative study provided a way to discover the core essential meanings of clinical intuition. Furthermore, it created the foundation for future studies in this area. The participants were comprised of nine licensed professional counselors in the state of North Carolina and all met the criteria for this study. Their experience ranged from 5 years to 36 years. These counselors worked in diverse settings and had acquired various kinds of postgraduate training. Interviews were conducted in the offices where counselors usually work with clients. Transcriptions of those interviews yielded the data that were analyzed and synthesized based on Moustakas’ (1994) phenomenological method. That process involved the Epoche, phenomenological reduction, imaginative variation, and synthesis. The data revealed six core themes: (1) unconscious associations; (2) conscious associations; (3) moments preceding the arrival of intuitive knowledge; (4) initial appearance; (5) manifestation of intuitive knowledge; and (6) the nature of the intuitive information. Each of the six themes was composed of clusters. Within the first theme of unconscious associations, participants made inferences about clinical knowledge and countertransference reactions that had occurred outside of their conscious awareness. The second theme of conscious associations contained counselors’ attention to their identification and resonance with clients as well as their countertransference to clients. This theme also included awareness of clinical knowledge and clients’ nonverbal and verbal communication. The third theme concerned the accepting, present, and expectant qualities that preceded the arrival of the intuitive knowledge. The fourth theme captured the holistic, immediate, certain, and sacred characteristics that seemed to imbue the presentation of the intuitive information. The fifth theme captured the way clinical intuition manifested in counselors, and it seemed to conform to the sixth theme which described the degree and quality of that information. Clinical intuition appeared to be a slow development of increasing levels of unconscious and conscious associations. In a state of alert receptivity, something in the clinical situation seemed to catalyze those developing connections. Counselors experienced that moment as a felt sense, gut feeling, recognition of a pattern, or symbolic representation. The manner in which clinical intuition arrived seemed to correspond with the degree of consciousness and the amount of affective and cognitive material contained in the knowledge. These findings were reviewed in relation to the relevant literature on intuition. The implications of this study to the field of counseling were also offered. Furthermore, suggestions for future studies on this topic were provided

'Family comes in all forms, blood or not': disrupting dominant narratives around the patriarchal nuclear family

After nearly 25 years of democracy, lives of young South Africans are still profoundly shaped by the legacies of apartheid. This paper considers how these differences are produced, maintained and disrupted through an exploration of changing narratives developed by a small group of South African pre-service teachers, with a particular focus on the narratives developed around discourses of fatherhood generally and absent fathers in particular. We draw on interviews conducted with three students in which we discussed their digital stories and literature reviews. In this paper, we draw attention to the limitations of digital storytelling and the risks such autobiographical storytelling presents of perpetuating dominant narratives that maintain and reproduce historical inequalities. At the same time, in highlighting ways in which this risk might be confronted, the paper also aims to show the possibilities in which these dominant narratives may be challenged.IBS

Routine Rapid HIV Screening in Six Community Health Centers Serving Populations at Risk

In 2006, to increase opportunities for patients to become aware of their HIV status, the Centers for Disease Control and Prevention released updated guidelines for routine, opt-out HIV screening of adults, adolescents, and pregnant women in healthcare settings. To date, there are few documented applications of these recommendations. To measure the impact of application of the guidelines for routine screening in health centers serving communities disproportionately affected by HIV in the southeastern US. A multi-site program implementation study, describing patients tested and not tested and assessing changes in testing frequency before and after new guidelines were implemented. All patients aged 13 to 64 seen in participating health centers. Routine rapid HIV screening in accord with CDC guidelines. The frequency of testing before and after routine screening was in place and demographic differences in offering and receipt of testing. Compared to approximately 3,000 patients in the year prior to implementation, 16,148 patients were offered testing with 10,769 tested. Of 39 rapid tests resulting in preliminary positives, 17 were newly detected infections. Among these patients, 12 of 14 receiving referrals were linked to HIV care. Nineteen were false positives. Younger patients, African Americans and Latinos were more likely to receive testing. By integrating CDC-recommended guidelines and applying rapid test technology, health centers were able to provide new access to HIV testing. Variation across centers in offering and receiving tests may indicate that clinical training could enhance universal access

Does directly observed therapy (DOT) reduce drug resistant tuberculosis?

<p>Abstract</p> <p>Background</p> <p>Directly observed therapy (DOT) is a widely recommended and promoted strategy to manage tuberculosis (TB), however, there is still disagreement about the role of DOT in TB control and the impact it has on reducing the acquisition and transmission of drug resistant TB. This study compares the portion of drug resistant genotype clusters, representing recent transmission, within and between communities implementing programs differing only in their directly observed therapy (DOT) practices.</p> <p>Methods</p> <p>Genotype clusters were defined as 2 or more patient members with matching IS<it>6110 </it>restriction fragment length polymorphism (RFLP) and spoligotype patterns from all culture-positive tuberculosis cases diagnosed between January 1, 1995 and December 31, 2001. Logistic regression was used to compute maximum-likelihood estimates of odds ratios (ORs) and 95% confidence intervals (CIs) comparing cluster members with and without drug resistant isolates. In the universal DOT county, all patients received doses under direct observation of health department staff; whereas in selective DOT county, the majority of received patients doses under direct observation of health department staff, while some were able to self-administer doses.</p> <p>Results</p> <p>Isolates from 1,706 persons collected during 1,721 episodes of tuberculosis were genotyped. Cluster members from the selective DOT county were more than twice as likely than cluster members from the universal DOT county to have at least one isolate resistant to isoniazid, rifampin, and/or ethambutol (OR = 2.3, 95% CI: 1.7, 3.1). Selective DOT county isolates were nearly 5 times more likely than universal DOT county isolates to belong to clusters with at least 2 resistant isolates having identical resistance patterns (OR = 4.7, 95% CI: 2.9, 7.6).</p> <p>Conclusions</p> <p>Universal DOT for tuberculosis is associated with a decrease in the acquisition and transmission of resistant tuberculosis.</p