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Indications of a care deficit for older adults in Africa and the need for long-term care that is acceptable for recipients and providers is well established, as are calls for its format to be ‘home-grown’. However, there is a discrepancy between the desire for evidenced African solutions, and the framing of both the problem and possible solutions derived from the Global North. This article draws on qualitative data from men and women needing and providing care in rural southern Malawi to challenge the implied universalism of the key terms of reference in the African long-term care discourse: ‘care’ and ‘family’.

Glioblastoma multiforme (GBM) is an aggressive variant of central nervous system gliomas that carries a dismal prognosis. Although GBM is the most frequently occurring and malignant type of glioma accounting for more than 60% of all brain tumors in adults, its overall incidence is rare, occurring at a rate of 3.21 per 100,000 persons. Little is known about the etiology of GBM, but one proposed theory is that GBM pathogenesis may be linked to a chronic inflammatory course initiated by traumatic injury to the brain. Limited case reports have suggested an association between GBMs and traumatic brain injury (TBI), but larger case–control and epidemiologic studies have been inconclusive. We present three service members (two active duty and one retired) who developed GBM near the original site of prior head trauma. Each service member’s military occupation was in the special operations community and shared a common theme of TBI following head trauma/injury. The current research on the association between TBI and GBM is limited and conflicting, predominantly due to the low incidence of the disease in the general population. Evidence has indicated that TBI should be considered a chronic disease with long-term health impacts, including long-term disability, dementia, epilepsy, mental health conditions, and cardiovascular diseases. With the addition of our patients, as well as a recently published study proposing a molecular association between trauma and GBM, further research is needed to better understand the potential relationship.

Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4–22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.

Parent–child interactions are critical for a child’s overall wellbeing and growth, however there are differences in the types of interactions that mothers and fathers engage in. For example, fathers often utilize physical play, such as Rough-and-Tumble Play (RTP), to interact and bond with their child. Father-child RTP appears to contribute to a range of child outcomes, including social, emotional cognitive and behaviour development. Given the now robust evidence for these benefits of father–child play and RTP specifically, there is a need for a more complete understanding of the factors that contribute to the quality of fathers’ RTP. This study examined the association between quality of father–toddler RTP and a range of paternal characteristics, parenting factors, child demographics and child developmental domains. The study included 64 sets of parents (mothers and fathers) and their toddler (age 18–24 months). Parent-reported questionnaires (demographic information, frequency of father–toddler RTP, father parenting stress, and child social-emotional development) were collected, observations of child developmental attainment (Bayley-III) completed and father–toddler RTP play interactions were rated for quality. We found that RTP for fathers who engaged in more father–toddler RTP, whose children were older and more socially-emotionally mature, was rated as higher quality in their RTP. By demonstrating links of RTP quality with both parenting behaviour and child development, this study contributes to a more complete understanding of the nature and context of father–child interactions. Father–child physical play, including RTP, may present an opportunity for professionals to bring fathers into their work with families.

The development and regeneration of skeletal muscle are mediated by satellite cells (SCs), which ensure the efficient formation of myofibers while repopulating the niche that allows muscle repair following injuries. Pannexin 1 (Panx1) channels are expressed in SCs and their levels increase during differentiation in vitro, as well as during skeletal muscle development and regeneration in vivo. Panx1 has recently been shown to regulate muscle regeneration by promoting bleb-based myoblast migration and fusion. While skeletal muscle is largely influenced in a sex-specific way, the sex-dependent roles of Panx1 in regulating skeletal muscle and SC function remain to be investigated. Here, using global Panx1 knockout (KO) mice, we demonstrate that Panx1 loss reduces muscle fiber size and strength, decreases SC number, and alters early SC differentiation and myoblast fusion in male, but not in female mice. Interestingly, while both male and female Panx1 KO mice display an increase in the number of regenerating fibers following acute injury, the newly formed fibers in male Panx1 KO mice are smaller. Overall, our results demonstrate that Panx1 plays a significant role in regulating muscle development, regeneration, and SC number and function in male mice and reveal distinct sex-dependent functions of Panx1 in skeletal muscle.

Rough-and-tumble play (RTP) between fathers and children has been linked to many social, emotional, and behavioural child outcomes, such as reduced aggression and increased self-regulation. This study extends our understanding of the importance of RTP to the development of the executive function, working memory. Father–child dyads (N = 30) were asked to play two RTP games that were videorecorded for later observational coding. Fathers were also asked to report the frequency with which they play RTP games with their child. Two measures of working memory were also collected. The working-memory index of the Wechsler Preschool and the Primary Scale of Intelligence—Fourth Edition were used to measure working-memory ability, and the working-memory subscale of the Behaviour Rating Inventory of Executive Function was used as a measure of working-memory problems. RTP frequency was associated with improved working-memory ability and fewer working-memory problems. RTP quality was associated with higher working-memory ability. This study adds to the growing evidence of the importance of father–child RTP for child development.

Involving people living with dementia in service design and planning has become more common in high-income countries. It remains rare in low- and middle-income countries where two-thirds of the world’s people with dementia live. In this commentary article, we explore the barriers to inclusion of people living with dementia in planning in low- and middle-income countries and make a case for the inclusion of people living with dementia in care and service planning. We suggest how this can be done at individual, community or national and state level using the following principles: 1) respecting the rights of people living with dementia to self-determination; 2) valuing people living with dementia’s unique understanding of dementia; 3) creating a culture of active inclusion which creates a space for people living with dementia to participate and 4) ensuring appropriate accommodations are in place to maximise participation.

Historically, the evaluation and assessment of the clinical response to treatment for canine back pain is subjective and relies on owner and clinician assessment of pain. This study evaluated the use of sequential infrared thermal images as a measure of the response of canine patients with back pain to a prescribed series of photobiomodulation therapy (PBMT) treatments. Qualifying participants had histories of pain and dysfunction associated with spinal osteoarthritis or intervertebral disk disease, or of non-specific uni- or bilateral back pain along the paravertebral epaxial muscles. Each patient was initially thermally imaged prior to PBMT treatment and then received multiple PBMT treatments delivered to the appropriate spinal area on days 1, 2, 3, and 4. Participants were reimaged on day 7. Thermal images provided an objective measure of superficial temperature changes over the area of PBMT treatment of each patient after the PBMT regimen. The temperature correlated with statistically significant changes in Colorado State University Canine Chronic Pain Scale scoring (CPS) and owner assessment using the Canine Brief Pain Inventory (CBPI), which includes a Pain Severity Score (PSS) and Pain Interference Score (PIS). The correlation of objective thermal imaging data with more subjective outcome measures suggests thermal imaging may be a valuable additional tool in monitoring therapy outcome.

This article provides descriptive insights of the experiences of family caregivers of persons living with dementia during the COVID-19 pandemic. Data were generated as part of a qualitative cross-national project to explore the costs and consequences of providing unpaid dementia care. Participants in Jamaica, who were recruited using community gatekeepers, information booths at health fairs, conferences, and other outreach events, were contacted by telephone to discuss their experiences of the pandemic. When face-to-face in-depth interview data collection was suspended due to the pandemic, ethical approval was received to contact all research participants who were informal unpaid family caregivers, both those whose care recipients had died and those who were active caregivers ( N = 19). Participants in this study were the 10 active family caregivers ( n F = 8; aged 45+; 60% from high socio-economic status). Their updates and reflections during these calls were documented in fieldnotes and analyzed for key themes. Data showed that the pandemic has illustrated the direct costs, both financial and otherwise, that informal dementia carers bear in Jamaica. It also intensified pre-existing challenges faced by family carers. We provide recommendations for sustainable support for family carers.

Evidence from middle-income countries indicates high and increasing prevalence of dementia and need for services. However, there has been little investment in care, treatment or support for people living with dementia and their carers. The Strengthening Responses to Dementia in Developing Countries (STRiDE) project aims to build both research capacity and evidence on dementia care and services in Brazil, Indonesia, India, Jamaica, Kenya, Mexico and South Africa. This article presents the Theory of Change (ToC) approach we used to co-design our research project and to develop a strategic direction for dementia care, treatment and support, with stakeholders. ToC makes explicit the process underlying how a programme will achieve its impact. We developed ToCs in each country and across the STRiDE project with researchers, practitioners, people living with dementia, carers and policymakers at different levels of government. This involved (1) an initial ToC workshop with all project partners (43 participants); (2) ToC workshops in each STRiDE country (22–49 participants in each); (3) comparison between country-specific and overall project ToCs; (4) review of ToCs in light of WHO dementia guidelines and action plan and (5) a final review. Our experiences suggest ToC is an effective way to generate a shared vision for dementia care, treatment and support among diverse stakeholders. However, the project contribution should be clearly delineated and use additional strategies to ensure appropriate participation from people living with dementia and their carers in the ToC process.

Father–child play engagement has been linked to a variety of child developmental outcomes. However, the most prevalent types of play and child developmental outcomes utilised in research remains unclear. The aim of this study was to systematically review the literature on father–child play interactions and the association with child developmental outcomes for children aged 0–10 years. Database searches generated 1622 abstracts that matched the specified search criteria. Abstract screening and full-text review resulted in 39 included publications. The systematic review revealed that while some paternal play behaviours resulted in different impacts across play types, others reported similar impacts. The findings of this review have implications for potential interventions and parenting resources.

Background: Social and health inequities place marginalized populations at increased risk of contracting the novel coronavirus 2019 (COVID-19). While COVID-19 literature continues to accumulate, there remains a lack of comprehensive epidemiological data on COVID-19 in children. The study aims to identify demographic trends in disease severity amongst COVID-19 positive pediatric patients. Methods: We analyzed the medical records of 2217 laboratory-confirmed COVID-19 pediatric patients, ages 0-18, across Indiana. Working with Regenstrief Institute Center of Biomedical Informatics, data was extracted from the databases of Indiana Network for Patient Care, Indiana University Health, and Eskenazi Health from February 28th, 2020 to July 13th, 2020. Factors of interest were age, race, and ethnicity. The study assessed the clinical outcome of disease severity which was defined by one of the following clinical designations: outpatient management exclusively, emergency care without hospital admission, non-pediatric intensive care unit (PICU) hospitalization, PICU hospitalization, and death. Results: The laboratory confirmed COVID-19 pediatric cohort was composed of 12.2% (N= 270) Black or African American, 49.3% (N=1094) white, and 3.2% (N= 71) American Indian/Alaska Native, Asian/Pacific Islander, and Multiracial combined group. 34.4% of Black or African American patients required emergency (12.2%) or inpatient care (22.2%) while 24.4% white patients required emergency (7.0%) or inpatient care (17.3%). 17.6% of the cohort was 0-5 years old, 24.8% was 6-12 years old, and 57.6% was 13-18 years old. 30.9% of the 0-5 age group required emergency or inpatient care while the percentages of the 6-12 age group and 13-18 age group requiring emergency or inpatient care were 20.6% and 18.9%, respectively. Conclusion: While our data is preliminary and requires additional validation, our exploration of racial and age disproportionalities in pediatric coronavirus severity serves to expand on the current COVID-19 literature and understanding of this virus.

The STRiDE project sets out to support the development of effective dementia policy in middle-income countries (Brazil, India, Indonesia, Jamaica, Kenya, Mexico, and South Africa). As part of this it will generate new data about the prevalence of dementia for a subset of these countries. This study aims to identify the current estimates of dementia prevalence in these countries and where the gaps lie in the current literature. A systematic review was completed on 30th April 2019 across electronic databases, identifying dementia prevalence literature originating from any of the seven countries. Four hundred and twenty-nine records were identified following de-duplication; 28 studies met the inclusion criteria and were included in the systematic review. Pooled estimates of dementia prevalence ranged from 2% to 9% based on DSM-IV criteria; these figures were generally higher in studies using other diagnostic criteria (e.g. the 10/66 algorithm). Available prevalence data varied between countries. Only Brazil, Mexico and India had data derived from studies judged as having a low risk of bias. Irrespective of country, studies often were not explicit in detailing the representativeness of their sample, or whether there was non-response bias. Further transparent and externally valid dementia prevalence research is needed across the STRiDE countries.

Exposure to early life stress has been linked to impairment in cognitive functioning in adulthood. The aim of this study was to systematically review the literature on the relationship between early life stress and working memory, a central component of cognitive functioning. Database searches yielded 358 abstracts matching the search terms. Abstract screening followed by full-text review resulted in 26 publications suitable for inclusion, of which 23 were included in the meta-analysis. Results of the meta-analysis suggested exposure to early life stress was associated with poorer working memory. Even though there were a wide variety of working memory tasks used, this effect was significant for both phonological and visuospatial working memory tasks, and both visual and aural task presentation modalities. The effect was also found in samples with and without clinical psychopathology. This review provides recommendations for future research and implications for clinical practice.

The aim of this study was to examine how accuracy and confidence in working memory performance relates to academic achievement as assessed in the Australian national curriculum assessment (National...

To examine primary care provider (PCP) screening practice for obstructive sleep apnea (OSA) and predictive factors for screening habits. A secondary objective was to describe the polysomnography completion proportion and outcome. We hypothesized that both provider and child health factors would predict PCP suspicion of OSA.A computer decision support system that automated screening for snoring was implemented in 5 urban primary care clinics in Indianapolis, Indiana. We studied 1086 snoring children aged 1 to 11 years seen by 26 PCPs. We used logistic regression to examine the association between PCP suspicion of OSA and child demographics, child health characteristics, provider characteristics, and clinic site.PCPs suspected OSA in 20% of snoring children. Factors predicting PCP concern for OSA included clinic site (P .01; odds ratio [OR] = 0.13), Spanish language (P .01; OR = 0.53), provider training (P = .01; OR = 10.19), number of training years (P = .01; OR = 4.26) and child age (P .01), with the youngest children least likely to elicit PCP concern for OSA (OR = 0.20). No patient health factors (eg, obesity) were significantly predictive. Proportions of OSA suspicion were variable between clinic sites (range, 6-28%) and between specific providers (range, 0-63%). Of children referred for polysomnography (n = 100), 61% completed the study. Of these, 67% had OSA.Results suggest unexplained small area practice variation in PCP concern for OSA among snoring children. It is likely that many children at risk for OSA remain unidentified. An important next step is to evaluate interventions to support PCPs in evidence-based OSA identification.

Introduction Pharmaceutical risk minimization programs involve interventions designed to support safe and appropriate use of medicines. Currently, information regarding the evaluation of these programs is not publicly reported in a standardized and transparent manner. To address this gap, we developed and piloted a quality reporting checklist entitled the Reporting recommendations Intended for pharmaceutical risk Minimization Evaluation Studies (RIMES). Methods Checklist development was guided by three sources: (1) a theoretical framework derived from program theory and process evaluation; (2) public health intervention design and evaluation principles; and (3) a review of existing quality reporting checklists. Two raters independently reviewed 10 recently published (2012–2016) risk minimization program evaluation studies using the proposed checklist. Inter-rater reliability of the checklist was assessed using Cohen’s Kappa and Gwet’s AC1. Results A 43-item checklist was generated. Results indicated substantial inter-rater reliability overall (κ = 0.65, AC1 = 0.65) and for three (key information, design and evaluation) of the four subscales (κ ≥ 0.64, AC1 ≥ 0.64). The fourth subscale (implementation) showed low reliability based on Cohen’s Kappa, but substantial reliability based on the AC1 (κ = 0.17, AC1 = 0.61). Conclusions The RIMES statement augments relevant elements from existing quality reporting guidelines with items that address aspects of intervention design, implementation and evaluation specific to pharmaceutical risk minimization programs. Our results show that the RIMES statement reliably measures key dimensions of reporting quality. This tailored checklist is an important first step in improving the reporting quality of risk minimization evaluation studies and may ultimately help to improve the quality of these interventions themselves.

Although there is increasing evidence of paternal influence on child outcomes such as language and cognition, researchers are not yet clear on the features of father-child play that are most valuable in terms of child development. Physical play such as rough and tumble play (RTP) is a favored type of father-child play in Western societies that has been linked to children's socioemotional competence. It is important, therefore, to determine the implications of this play for child development. In this review and meta-analysis, associations between father-child physical play and child behavior were examined. The review also focused on study methods. Sixteen studies are reviewed, N = 1,521 father-child dyads, 35% boys. Study characteristics such as definitions of physical play, play settings, play measures, and coding were examined. The meta-analysis found weak to moderate population effects for links between father-child physical play and child aggression, social competence, emotional skills, and self-regulation. Research investigating the effect of father-child physical play on children's development will be improved when definitions clearly identify the nature of play, settings facilitate boisterous play, and measures include frequency and quality of play interactions. This play shows promise as an enhancer of positive father-child relationships and a catalyst for child development.

Low working memory (WM) capacity has been linked to poor academic performance and problem behavior. Availability of easy-to-administer screening tests would facilitate early detection of WM deficits. This study investigated the psychometric properties of the Working Memory Power Test for Children (WMPT) in 170 Australian schoolchildren (8½-11 years). Reliability (internal consistency) and validity of WMPT accuracy scores were examined. WMPT accuracy predicted achievement in reading, numeracy, and spelling. The results provide preliminary evidence of reliability and validity that supports interpretation of the WMPT accuracy score. With additional research, the WMPT could be valuable as an easy-to-administer screener for WM deficits.

The relationship between metacognitive monitoring of working memory performance and academic achievement was examined in 73 Grade 4 children. Working memory was assessed using the Working Memory Power Test (WMPT) for children. Metacognitive monitoring was assessed by confidence ratings and two calibration measures, the Bias Index and the Absolute Accuracy Index, calculated from WMPT scores. Children also completed the Wechsler Individual Achievement Test - Australian Abbreviated (WIAT-II). Regression analyses showed the Bias Index was the best metacognitive monitoring calibration measure for predicting academic achievement. These findings extend previous research in two important ways. Firstly, we have shown that Grade 4 children have metacognitive monitoring abilities. Secondly, we have demonstrated that children are able to metacognitively monitor their working memory performance and that the calibration of this monitoring is related to their academic achievement.

PURPOSE In recent years, novel types of real-world evidence (RWE) have played a role in various decision-making processes relating to medicinal products, including regulatory approval, patient access, health technology assessment, safety monitoring, clinical use, and post-approval lifecycle management. We therefore reviewed the potential utility of RWE in the cycle of medicinal product benefit-risk (BR) assessment, communication/risk minimization and evaluation ("BRACE"). METHODS A convenience sample of illustrative studies was drawn from the published literature and examined. Specifically, we examined the purpose for using RWE, the type of RWE used, its novelty and how it might be integrated with other data and activities of the BRACE cycle, and how it contributed to regulatory decision-making. RESULTS Eight studies were selected with each illustrating a different activity in the BRACE cycle ranging from BR assessment in the preapproval setting, post-approval assessment of safety or effectiveness, communicating BR information to patients and healthcare professionals, and evaluating the effectiveness of risk minimization initiatives to support a positive BR balance. CONCLUSIONS RWE has an important role in informing regulatory decision-making regarding the BR management of medicines. With increasing digitalization, facilitating data collection and stakeholder engagement in health, this role is only expected to expand in the future. To reach the full potential of RWE, both regulators and sponsors will need to be familiar with a range of existing and emerging methods for generating and analyzing such evidence appropriately and achieve convergence regarding how different types of RWE can best be used to inform BR management and decision-making.

Feminist theory rose in prominence in educational research during the 1980s and experienced a resurgence in popularity during the late 1990s−2010s. Standpoint epistemologies, intersectionality, and feminist poststructuralism are the most prevalent theories, but feminist researchers often work across feminist theoretical thought. Feminist qualitative research in education encompasses a myriad of methods and methodologies, but projects share a commitment to feminist ethics and theories. Among the commitments are the understanding that knowledge is situated in the subjectivities and lived experiences of both researcher and participants and research is deeply reflexive. Feminist theory informs both research questions and the methodology of a project in addition to serving as a foundation for analysis. The goals of feminist educational research include dismantling systems of oppression, highlighting gender-based disparities, and seeking new ways of constructing knowledge.

Purpose The purpose of this project was to improve the accuracy of newborn weight classification using a regional newborn growth reference (Olsen), an evidence-based method, to determine SGA, AGA and LGA in term infants compared to the current growth reference (Lubchenco). Design Quality improvement methods using Lewin's Change Theory guided the process. Setting/local problem At an academic medical center term infants were evaluated for weight-for-gestational age using the Lubchenco growth reference as well as other growth references based on provider preference. Patients All term newborns (N = 314) admitted to the newborn nursery during one month following a 3-months implementation of the practice change. Intervention/measurements Newborn nursery nursing staff and provider staff were provided education and training on using and interpreting the new growth reference. Results Use of the Olsen regional growth reference identified more infants as small and fewer infants as large for gestational age. Post hoc analysis with a more global growth reference (Fenton) also identified more infants as small and fewer infants as large for gestational age. There was no statistically significant difference between the Olsen or Fenton growth references. Conclusion Use of either of these two updated growth references more accurately classifies infant weight for gestational age compared to the Lubchenco growth reference, potentially decreasing newborn health risks such as hypoglycemia.

OBJECTIVES: To reduce average length of stay (ALOS) in infants with neonatal abstinence syndrome (NAS) transferred to the inpatient floor from the mother-infant unit. Secondarily, we aimed to reduce morphine exposure in these infants. METHODS: Using quality improvement methodology, we redesigned our approach to NAS on the inpatient floor. Key interventions included transitioning from a modified Finnegan Neonatal Abstinence Scoring System to the “Eat, Sleep, Console” method for withdrawal assessment, reeducation on nonpharmacologic interventions, and adding as-needed morphine as initial pharmacotherapy. Data for infants ≥35 weeks’ gestation with confirmed in utero opioid exposure and worsening symptoms of NAS requiring transfer to the inpatient floor were obtained, including ALOS, number of morphine doses, and total morphine amount administered. Infants with conditions requiring nothing by mouth for >12 hours or morphine initiation in the ICU were excluded. RESULTS: ALOS for infants (baseline n = 40; intervention n = 36) with NAS transferred to the inpatient floor decreased from 10.3 to 4.9 days. Average morphine administered decreased from 38 to 0.3 doses per infant. No infant in the intervention period required scheduled morphine. The percent of all infants transferred to the floor for NAS requiring any morphine decreased from 92% at baseline to 19% postimplementation. There were no observed adverse events or NAS-related readmissions in the intervention period. CONCLUSIONS: Transitioning to the Eat, Sleep, Console assessment with re-enforcement of nonpharmacologic care and use of as-needed morphine as initial pharmacotherapy resulted in a notably decreased ALOS and near elimination of postnatal opioid treatment of infants with NAS managed on our inpatient floor.

The potential health consequences of limiting access to safe abortion make it imperative to understand how conscience-based refusal to provide legally permitted services is understood and carried out by healthcare practitioners. This in-depth study of conscientious objection to abortion provision in Zambia is based on qualitative interviews (N = 51) with practitioners working across the health system who object and do not object to providing abortion services in accordance with their cadre. Interviews were conducted in September 2015. Regardless of whether practitioners self-identified as providers or non-providers of abortion services, they presented similar religiously-informed understandings of abortion as a morally-challenging practice that is, or is not, shifted from iniquity to acceptability based on the reasons for which it has been requested or the likelihood of unsafe abortion if services are not provided. These contextual factors presented a series of tipping points for participants, rather than a single justification for providing abortion. Subsequently both groups reported that their decisions about providing services were complex and changeable, rather than clear one-time resolutions. This shaped their practices, both in terms of whether or not they provided services, and when and how they delivered them. Practitioners self-identifying as non-providers, and those self-identifying as providers, reported provision, counselling, and referral practices likely to lessen women's access to safe legal abortion. In this way, conscientious objection in practice could be understood as a continuum of behaviours rather than a binary position. Our results suggest that data on prevalence of claims to conscientious objector status may underestimate the impact of practitioners' religious, moral and ethical beliefs on abortion accessibility. In Zambia, eliminating practitioners' right to conscientious objection alone or conducting rights-based advocacy may therefore not significantly increase access to safe abortion.