Stronger together: midwifery twinning between Tanzania and Canada

This article describes a twinning relationship between the Canadian Association of Midwives (CAM) and the Tanzania Midwives Association (TAMA). It argues that the twinning relationship strengthened both associations. The article briefly reviews the existing literature on professional associations and association strengthening to demonstrate that professional associations are a vital tool for improving the performance of healthcare workers and increasing their capacity to contribute to national and international policy-making. It then suggests that midwifery associations are particularly significant given the frequent professional marginalization of midwives. The article then describes in depth the relationship between CAM and TAMA, highlighting the accomplishments of the twinned partners, and analyzing the factors that contributed to the success of the relationship. The findings demonstrate that twinning can successfully strengthen associations, increasing their ability to support their membership, care for the public, and shape national policy-making. The article therefore proposes twinning as a successful and cost-effective model for encouraging the growth of the midwifery profession.     

Single‐item measure of food insecurity used in the National Health Survey may underestimate prevalence in Australia

Objectives : To compare prevalence estimates of food insecurity using a single‐item measure, with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA‐FSSM). Methods : Data were collected by postal survey, from individuals aged ≥18 years from disadvantaged suburbs of Brisbane, Australia (n= 505, 53% response). Food security status was ascertained by the Australian single‐item measure, and the 6‐, 10‐ and 18‐item versions of the USDA‐FSSM. Prevalence estimates of food insecurity and different levels of severity of food insecurity estimated by each tool were determined. Data were analysed using McNemar's test, polychoric correlation and Rasch analyses. Results : The prevalence of food insecurity was 19.5% using the single‐item measure; significantly less than the 24.4%, 22.8% and 21.1% identified using the 18‐item, 10‐item and 6‐item versions of the USDA‐FSSM, respectively. Rasch analyses revealed that overall the USDA‐FSSM may be a valid tool for the measurement of food insecurity within the current sample. Conclusion : The measure of food insecurity employed in national surveys in Australia may underestimate its prevalence and public health significance. Implications for public health : Future monitoring and surveillance efforts should seek to employ a more accurate measure as the first step in recognising the right to food for all Australians.     

Ethnic Discrimination and Smoking-Related Outcomes among Former and Current Arab Male Smokers in Israel: The Buffering Effects of Social Support

We examined the relationship between two forms of ethnic discrimination—interpersonal and institutional—and smoking outcomes among Arab men in Israel, and whether social support buffered these associations. We used cross-sectional data of adult Arab men, current or former smokers (n?=?954). Mixed-effects regression models estimated the association between discrimination and smoking status, and nicotine dependence among current smokers. Interpersonal discrimination was associated with higher likelihood of being a current smoker compared to a former smoker, whereas institutional group discrimination was not. Social support moderated the ethnic discrimination-nicotine dependence link. Among men with low social support, greater interpersonal discrimination was associated with greater nicotine dependence. Similarly, among smokers with high institutional group discrimination, those with high social support reported lower nicotine dependence compared to those with low social support. Ethnic discrimination should be considered in efforts to improve smoking outcomes among Arab male smokers in Israel.     

A Rights-Based Approach for Service Providers to Measure the Quality of Life of Children with a Disability

Background

This paper identifies the best instruments for service providers to measure the quality of life (QoL) of children with a disability, with a focus on their alignment with the Convention on the Rights of Persons with a Disability (CRPD).

Shear-dependent platelet aggregation size

Nonsurgical bleeding is the most frequent complication of left ventricular assist device (LVAD) support. Supraphysiologic shear rates generated in LVAD causes impaired platelet aggregation, which increases the risk of bleeding. The effect of shear rate on the formation size of platelet aggregates has never been reported experimentally, although platelet aggregation size can be considered to be directly relevant to bleeding complications. Therefore, this study investigated the impact of shear rate and exposure time on the formation size of platelet aggregates, which is vital in predicting bleeding in patients with an LVAD. Human platelet-poor plasma (containing von Willebrand factor, vWF) and fluorochrome-labeled platelets were subjected to a range of shear rates (0-10 000 s⁻¹) for 0, 5, 10, and 15 minutes using a custom-built blood-shearing device. Formed sizes of platelet aggregates under a range of shear-controlled environment were visualized and measured using microscopy. The loss of high molecular weight (HMW) vWF multimers was quantified using gel electrophoresis and immunoblotting. An inhibition study was also performed to investigate the reduction in platelet aggregation size and HMW vWF multimers caused by either mechanical shear or enzymatic (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13—ADAMTS13, the von Willebrand factor protease) mechanism under low and high shear conditions (360 and 10 000 s⁻¹). We found that the average size of platelet aggregates formed under physiological shear rates of 360-3000 s⁻¹ (200-300 μm²) was significantly larger compared to those sheared at >6000 s⁻¹ (50-100 μm²). Furthermore, HMW vWF multimers were reduced with increased shear rates. The inhibition study revealed that the reduction in platelet aggregation size and HWM vWF multimers were mainly associated with ADAMTS13. In conclusion, the threshold of shear rate must not exceed >6000 s⁻¹ in order to maintain the optimal size of platelet aggregates to “plug off” the injury site and stop bleeding.