Pain and Palliative Care for People Living with HIV/AIDS in Asia

Millions of people living with HIV/AIDS (PLHA) in Asia need access to palliative care as part of a comprehensive response to their support needs. There are many causes of pain in HIV/AIDS, and its prevalence is as high if not higher than in cancer, but it is frequently undertreated. Access to adequate pain relief and palliative care is impeded by the barriers which face PLHA in Asia. These include few care and support services, lack of recognition and acknowledgement of pain in HIV/AIDS by health care professionals, widespread stigma and discrimination especially towards vulnerable groups such as injecting drug users, government regulatory mechanisms which make access to opioids even more difficult for the care services which have developed and a lack of understanding of or advocacy for pain relief and palliative care in the literature on HIV/AIDS care and support. During the growth of palliative care in Asia, there is opportunity for advocates of palliative care and care for PLHA to collaborate to influence national policy.     

New technologies reduce greenhouse gas emissions from nitrogenous fertilizer in China

Synthetic nitrogen (N) fertilizer has played a key role in enhancing food production and keeping half of the world’s population adequately fed. However, decades of N fertilizer overuse in many parts of the world have contributed to soil, water, and air pollution; reducing excessive N losses and emissions is a central environmental challenge in the 21st century. China’s participation is essential to global efforts in reducing N-related greenhouse gas (GHG) emissions because China is the largest producer and consumer of fertilizer N. To evaluate the impact of China’s use of N fertilizer, we quantify the carbon footprint of China’s N fertilizer production and consumption chain using life cycle analysis. For every ton of N fertilizer manufactured and used, 13.5 tons of CO₂-equivalent (eq) (t CO₂-eq) is emitted, compared with 9.7 t CO₂-eq in Europe. Emissions in China tripled from 1980 [131 terrogram (Tg) of CO₂-eq (Tg CO₂-eq)] to 2010 (452 Tg CO₂-eq). N fertilizer-related emissions constitute about 7% of GHG emissions from the entire Chinese economy and exceed soil carbon gain resulting from N fertilizer use by several-fold. We identified potential emission reductions by comparing prevailing technologies and management practices in China with more advanced options worldwide. Mitigation opportunities include improving methane recovery during coal mining, enhancing energy efficiency in fertilizer manufacture, and minimizing N overuse in field-level crop production. We find that use of advanced technologies could cut N fertilizer-related emissions by 20–63%, amounting to 102–357 Tg CO₂-eq annually. Such reduction would decrease China’s total GHG emissions by 2–6%, which is significant on a global scale.     

Access to Drug Abuse Treatment Under Treatment On Demand Policy in San Francisco

Objectives: We evaluated whether implementation of Treatment on Demand (TOD) policy in San Francisco was associated with improved access to drug abuse treatment. Methods: Data came from San Francisco's treatment program waiting list over 4 years spanning the implementation of TOD policy. Access measures were monthly applicants waiting and days waited by treatment admissions. Quantitative analyses with 69 treatment facilities contrasted those receiving vs. not receiving TOD funds. Qualitative data came from interviews with facility administrators. Results: There was a small statistically significant decline in monthly waiting lists in the number of people waiting for treatment during the study period. The days waited by those admitted to treatment, however, significantly increased in TOD-funded facilities. Facilities used varied criteria for completing the access measures, which limit the utility of the measures. Conclusions: Access to treatment improved slightly with implementation of TOD policy.     

Targeting global conservation funding to limit immediate biodiversity declines

Inadequate funding levels are a major impediment to effective global biodiversity conservation and are likely associated with recent failures to meet United Nations biodiversity targets. Some countries are more severely underfunded than others and therefore represent urgent financial priorities. However, attempts to identify these highly underfunded countries have been hampered for decades by poor and incomplete data on actual spending, coupled with uncertainty and lack of consensus over the relative size of spending gaps. Here, we assemble a global database of annual conservation spending. We then develop a statistical model that explains 86% of variation in conservation expenditures, and use this to identify countries where funding is robustly below expected levels. The 40 most severely underfunded countries contain 32% of all threatened mammalian diversity and include neighbors in some of the world’s most biodiversity-rich areas (Sundaland, Wallacea, and Near Oceania). However, very modest increases in international assistance would achieve a large improvement in the relative adequacy of global conservation finance. Our results could therefore be quickly applied to limit immediate biodiversity losses at relatively little cost.     

Pilates for people with multiple sclerosis who use a wheelchair: feasibility,efficacy and participant experiences

Abstract

Purpose: This mixed methods study aimed to explore the feasibility, efficacy and the participants’ experiences of a Pilates programme for people with Multiple Sclerosis (pwMS) who use a wheelchair. Method: Fifteen pwMS took part in the 12-week Pilates programme. At baseline and after 6 and 12 weeks of the programme, sitting stability, measured as maximum progression of the Centre of Pressure when leaning sideways (COPmax), posture, pain on a Visual Analogue Scale, function, fatigue and the impact of MS (MSIS29) were assessed. Ten participants took part in two focus groups within six weeks of the completion of the programme. Results: Significant improvements at the 12-week assessment were found in COPmax (p?=?0.046), sitting posture (p?=?0.004), pain in the shoulders (p?=?0.005) and back (p?=?0.005) and MSIS29 (p?=?0.006). The majority of participants described various physical, functional, psychological and social benefits from participation that reflected increased confidence in activities of daily living. Enjoyment of the classes was expressed by all, and most wished to continue participation. Conclusions: Pilates appears to be efficacious in improving sitting stability and posture and decreasing pain and was also well tolerated by wheelchair users with MS. Further mixed methods studies are warranted.

• Implications for Rehabilitation

• Group-based core stability exercise or Pilates for people with MS who use wheelchair is a feasible and safe way of exercising for this patient group.

• Pilates exercises for people moderately to severely affected by MS resulted in a decrease in back and shoulder pain and improvement in sitting balance.

• Future appropriately powered randomised controlled studies into Pilates for people with MS reliant on wheelchair are warranted.

     

Time for a shift in Australian rehabilitation?

Purpose. Tertiary rehabilitation, particularly in Australia, still costs a significant amount of money each year. Turnover in the rehabilitation industry is extremely high and rehabilitation professionals report being dissatisfied in their work. These ironic findings can be attributed to the state of tension in which rehabilitation finds itself. A decade ago, it was noted that tertiary rehabilitation counselling was facing the challenge of managing several conflicting forces and constantly shifting priorities. In the last decade, this challenge has intensified.

Method. A review of current data was undertaken to identify the primary tensions that have influenced rehabilitation over the last decade.

Results. Tensions were attributed to three sets of opposing forces related to the philosophy of rehabilitation, the economic imperative and the role of privatisation of the industry.

Conclusion. This paper argues the need for a fundamental shift in thinking if the rehabilitation discipline is to continue growing. Precedents exist that can assist rehabilitation to make a significant shift to a new model of thinking, but a great deal of attention must be focused on the legal, economic and medical barriers to that movement.     

Homeless youth in Seattle: Planning and policy-making at the local government level

Young people leave home for many reasons--a push away from problems, a pull toward the independence and seeming excitement of the street. Once on the street they face serious risks to their health and well-being. Homelessness among youths is a concern in Seattle, with as many as 2,000 on the street in a year's time. The service system is overburdened and poorly coordinated. The City of Seattle examined the problem, inadequacies of the service system, and issues affecting its ability to address the needs of homeless youths and their families. This article presents data on the problem, policies proposed to shape the city's response, and progress made in the last 2 years.