Search

This study assessed a preventive intervention home visiting programme (Fussy Baby Network (FBN)) designed to support mothers struggling with infant crying, sleeping, or feeding concerns. Mothers were referred to the programme through local health- and social service providers and were eligible to participate in the study if they were age 18 or older and had a child ≤12 months of age. A mixed methods design quantitatively assessed pre- to post-test changes in maternal mental health, parenting confidence, and parent-infant bonding and qualitatively explored mothers’ experiences of the programme. Statistically significant differences were found with effect sizes (Cohen’s D) as follows: improved parenting self-efficacy (0.72) and confidence (0.44); reduced maternal anxiety (0.50), stress (0.44), mother-infant bonding difficulties (0.42), and depression (0.35). Qualitative findings revealed that Empathic Inquiry and Capacity Building, two core processes of the FBN model, emerged as the most salient themes of the programme. [ABSTRACT FROM AUTHOR]

Coastal communities along the U.S. Gulf of Mexico have been profoundly shaped by environmental health (EH) threats, reflecting the region's history of natural and technological disasters, as well as ongoing issues of environmental degradation and pollution. The Vietnamese American community in the state of Mississippi is vulnerable to EH threats, but there is limited research on their risk perceptions. Understanding perceptions of risk and responsibility is important to manage EH risks and promote community resilience. This community-based participatory research study characterises Vietnamese American perceptions of EH risks, sources of information, and responsibility in coastal Mississippi. Five focus groups were conducted in 2016 and 2017 in Biloxi, Mississippi with Vietnamese Americans working in the seafood industry (n = 24) and mothers of children under the age of 18 (n = 25). Findings related to participants' concerns with air quality, drinking water quality, and the 2010 Deepwater Horizon oil spill are interpreted using Boholm's relational theory of risk. Unreliable access to healthcare and limited English proficiency constrain participants from acting on their environmental health risk relationships. A community-based organisation in Biloxi that works with Vietnamese Americans plays an important role in addressing risk in this population. [ABSTRACT FROM AUTHOR]

Objectives. To establish a validated, standardized set of core competencies for community health workers (CHWs) and a linked workforce framework. Methods. We conducted a review of the literature on CHW competency development (August 2015), completed a structured analysis of literature sources to develop a workforce framework, convened an expert panel to review the framework and write measurable competencies, and validated the competencies (August 2017) by using a 5-point Likert scale survey with 58 participants in person in Biloxi, Mississippi, and electronically across the United States. Results. The workforce framework delineates 3 categories of CHWs based upon training, workplace, and scope of practice. Each of the 27 competencies was validated with a mean of less than 3 (range = 1.12–2.27) and a simple majority of participants rated all competencies as "extremely important" or "very important." Conclusions. Writing measurable competencies and linking the competencies to a workforce framework are significant advances for CHW workforce development. Public Health Implications. The standardized core competencies and workforce framework are important for addressing health disparities and maximizing CHW effectiveness. [ABSTRACT FROM AUTHOR]

Background: Climate change is affecting food systems globally, with implications for food security, nutrition, and the health of human populations. There are limited data characterizing the current and future consequences of climate change on local food security for populations already experiencing poor nutritional indicators. Indigenous Amazonian populations have a high reported prevalence of nutritional deficiencies. This paper characterizes the food system of the Shawi of the Peruvian Amazon, climatic and non-climatic drivers of their food security vulnerability to climate change, and identifies potential maladaptation trajectories. Methods and findings: Semi-structured interviews with key informants (n = 24), three photovoice workshops (n = 17 individuals), transect walks (n = 2), a food calendar exercise, and two community dissemination meetings (n = 30 individuals), were conducted within two Shawi communities in Balsapuerto District in the Peruvian Loreto region between June and September of 2014. The Shawi food system was based on three main food sub-systems (forest, farming and externally-sourced). Shawi reported collective, gendered, and emotional notions related to their food system activities. Climatic and non-climatic drivers of food security vulnerability among Shawi participants acted at proximal and distal levels, and mutually reinforced key maladaptation trajectories, including: 1) a growing population and natural resource degradation coupled with limited opportunities to increase incomes, and 2) a desire for education and deforestation reinforced by governmental social and food interventions. Conclusion: A series of maladaptive trajectories have the potential to increase social and nutritional inequities for the Shawi. Transformational food security adaptation should include consideration of Indigenous perceptions and priorities, and should be part of Peruvian food and socioeconomic development policies. [ABSTRACT FROM AUTHOR]

Climate change adaptation is increasingly considered an urgent priority for policy action. Billions of dollars have been pledged for adaptation finance, with many donor agencies requiring that adaptation is distinct from baseline development. However, practitioners and academics continue to question what adaptation looks like on the ground, especially in a developing country. This study examines the current framing of planned adaptation amidst low socioeconomic development and considers the practical implications of this framing for adaptation planning. Three overarching approaches to planned adaptation in a developing country context emerged in a systematic review of 30 peer-reviewed articles published between 2010 and 2015, including: (1) technocratic risk management, which treats adaptation as additional to development, (2) pro-poor vulnerability reduction, which acknowledges the ability of conventional development to foster and act as adaptation, and (3) sustainable adaptation, which suggests that adaptation should only be integrated into a type of development that is socially and environmentally sustainable. Over half of 'sustainable adaptation' articles in this review took a critical adaptation approach, drawing primarily from political ecology and postdevelopment studies, and emphasizing the malleability of adaptation. The reviewed articles highlight how the different framings of the relationship between adaptation and development result in diverse and sometimes contradictory messages regarding adaptation design, implementation, funding, monitoring, and evaluation. This review illustrates the need to continually interrogate the multiple framings of adaptation and development and to foster a pragmatic and pluralistic dialogue regarding planned adaptation and transformative change in developing countries. WIREs Clim Change 2016, 7:707-726. doi: 10.1002/wcc.416 For further resources related to this article, please visit the . [ABSTRACT FROM AUTHOR]

Arctic regions are experiencing the most rapid climate change globally and adaptation has been identified as a priority across scales. Anticipatory planning to adapt to the impacts of climate change usually follows a number of steps: assess current and future vulnerability, identify potential adaptations, prioritize options, implement prioritized options, and monitor and evaluate implementation. While most of these steps are well documented, there has been limited examination of the process of adaptation prioritization in Arctic communities. In this paper, we build upon existing tools and propose a framework for prioritizing adaptation options and guiding decision-making for implementation in Arctic regions. Using four adaptation performance criteria (timescale, equity, sustainability and total costs) to evaluate options through a multi-criteria decision analysis coupled with a network centric approach, our Adaptation Prioritization Framework promotes a participatory approach for adaptation prioritization and planning. We illustrate application of the framework using a hypothetical example from the territory of Nunavut in the Canadian Arctic. [ABSTRACT FROM AUTHOR]

Institution-oriented, top-down and community-oriented, bottom-up stakeholder approaches are evaluated for their ability to enable or constrain the implementation of adaptation in developing nations. A systematic review approach is used evaluate the project performance of 18 adaptation projects by three of the Global Environment Facility's (GEF) adaptation programmes (the Strategic Priority for Adaptation (SPA), the Special Climate Change Fund (SCCF), and the National Adaptation Programs of Action (NAPA)) according to effectiveness, efficiency, equity, legitimacy, flexibility, sustainability, and replicability. The ten SPA projects reviewed performed highest overall, especially with regards to efficiency, legitimacy, and replicability. The five SCCF projects performed the highest in equity, flexibility, and sustainability, and the three NAPA-related projects were the highest-performing projects with regards to effectiveness. A comparison of top-down and bottom-up approaches revealed that community stakeholder engagement in project design and implementation led to higher effectiveness, efficiency, equity, flexibility, legitimacy, sustainability, and replicability. Although low institutional capacity constrained both project success and effective community participation, projects that hired international staff to assist in implementation experienced higher overall performance. These case studies also illustrate how participatory methods can fail to genuinely empower or involve communities in adaptation interventions in both top-down and bottom-up approaches. It is thus crucial to carefully consider stakeholder engagement strategies in adaptation interventions.Policy relevanceWhile adaptation is now firmly on the policy and research agenda, actual interventions to reduce vulnerability and enhance resilience remain in their infancy, and there is limited information on the factors that influence the successful implementation of adaptation in developing areas. Engaging stakeholders in assessing vulnerability and implementing adaptation interventions is widely regarded to be an important factor for adaptation implementation and success. However, no study has evaluated the effects of stakeholder engagement in the actual implementation of adaptation initiatives. Effective stakeholder engagement is challenging, especially in a developing nation setting, due to high levels of poverty, inadequate knowledge on adaptation options, weak institutions, and competing interests to address more immediate problems related to poverty and underdevelopment. In this context, this article documents and characterizes stakeholder engagement in adaptation interventions supported through the GEF, examining how top-down or bottom-up stakeholder approaches enable or constrain project performance. [ABSTRACT FROM AUTHOR]

Background: Current literature emphasizes the need to implement informed consent according to indigenous principles and worldviews. However, few studies explicitly address how informed consent can be effectively and appropriately obtained in indigenous communities in accordance with research ethics guidelines. Methods: This article uses participatory rural appraisal methods to identify and characterize community preferences for informed consent in two indigenous communities in the Peruvian Amazon, using Canadian federal research regulations and McGill University's Research Ethics Board as a case study to examine where institutional ethics guidelines constrain or support culturally appropriate notions of informed consent. Results: The study emphasizes the importance of tailoring informed consent procedures to community circumstances. Although both communities in this case study are located in the Peruvian Amazon, there were important distinctions between them, such as gender dynamics and social structure, which profoundly affected informed consent procedures. It is also important to consider the balance of collectivism and individualism at a community level in order to determine the role of individual and community consent. Conclusion: Research ethics guidelines generally allow for this contextualized approach. However, regulations still have the potential to constrain indigenous informed consent due to content requirements for informed consent forms, limited flexibility for modifications in the field, and requirements for individual consent. [ABSTRACT FROM PUBLISHER]

Caribbean small island developing states are highly exposed to climate change impacts. Incorporating weather and climate information into public health decisions can promote resilience to climate change's adverse health effects, but regionally it is not common practice. We implemented a project to enhance dialogue between climate and public health specialists in Puerto Rico and Dominica. First, we conducted environmental scans of public health vulnerability in the context of weather and climate for both islands. Then, we convened stakeholders to discuss the scan results and identify priorities for climate and health. A shared priority was increasing climate and health knowledge; thus, we developed several educational initiatives. In this viewpoint, we discuss our process for conducting environmental scans, building capacity and partnerships, and translating knowledge-to-action around climate and health., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Introduction: As of November 2021, COVID-19 has killed more than 5 million people globally, including over 750 000 in the USA. Apart from corticosteroids, most available therapeutic options are at best marginally efficient in reducing disease severity and are extremely expensive. The systematic investigation of clinically approved drugs is a priority to determine what does mitigate disease severity. Oestradiol (E2) and progesterone (P4) produce a state of anti-inflammatory immune responses and immune tolerance, and enhanced antibody production. The goal of this trial is to evaluate the efficacy of a short E2 and P4 therapy, in addition to standard of care (SOC), in mitigating disease severity in COVID-19 hospitalised patients., Methods and Analysis: Phase 2, randomised, double blind, placebo-controlled, single-centre trial. Patients hospitalised for confirmed COVID-19, with scores 3-5 on the 9-point WHO ordinal scale are randomised between two arms: (1) Oestradiol cypionate intramuscular (IM) and micronised progesterone oral (PO), in addition to SOC, and (2) placebo, in addition to SOC. The primary outcome is the proportion of patients improving to scores 1 or 2 on the WHO scale through day 28. Secondary outcomes include length of hospital stay, duration of mechanical ventilation, cause of death, readmission rates, change in inflammatory biomarkers between admission and occurrence of primary endpoint, and adverse events. Study sample size will be up to 120 participants. The trial is currently recruiting subjects., Ethics and Dissemination: The sponsor of this study is the Center of Excellence in Sex-Based Biology & Medicine at Tulane University, New Orleans, Louisiana, USA. Ethical approval was obtained from the Tulane institutional review board on 14 May 2021. The study was reviewed by the US Food and Drug Administration and granted Investigational New Drug #152 499. Results of the study will be submitted for publication in a peer-reviewed journal., Trial Registration Number: NCT04865029; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Community-based adaptation (CBA) has emerged over the last decade as an approach to empowering communities to plan for and cope with the impacts of climate change. While such approaches have been widely advocated, few have critically examined the tensions and challenges that CBA brings. Responding to this gap, this article critically examines the use of CBA approaches with Inuit communities in Canada. We suggest that CBA holds significant promise to make adaptation research more democratic and responsive to local needs, providing a basis for developing locally appropriate adaptations based on local/indigenous and Western knowledge. Yet, we argue that CBA is not a panacea, and its common portrayal as such obscures its limitations, nuances, and challenges. Indeed, if uncritically adopted, CBA can potentially lead to maladaptation, may be inappropriate in some instances, can legitimize outside intervention and control, and may further marginalize communities. We identify responsibilities for researchers engaging in CBA work to manage these challenges, emphasizing the centrality of how knowledge is generated, the need for project flexibility and openness to change, and the importance of ensuring partnerships between researchers and communities are transparent. Researchers also need to be realistic about what CBA can achieve, and should not assume that research has a positive role to play in community adaptation just because it utilizes participatory approaches. WIREs Clim Change 2016, 7:175-191. doi: 10.1002/wcc.376 For further resources related to this article, please visit the WIREs website.