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A column. Elvis and the advantages of illiteracy about Elvis and the advantages of illiteracy.
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At present, leading international agencies, such as the United Nations Environmental Programme, are largely focused on what they claim to be ‘win-win’ scenarios of ‘sustainable development’ rhetoric. These combine social, economic and environmental objectives. However, as noted by the ‘Scientists’ Warning to Humanity’, environmental integrity is the essential precondition for the healthy functioning of social and economic systems, and thus environmental protection needs to be prioritized in policy and practice. Ecological sustainability cannot be reached without realizing that population growth and economic growth, with attendant increased rates of depletion of natural resources, pollution, and general environmental degradation, are the root causes of unsustainability. This article argues that to strategically address ecological unsustainability, the social, economic and political barriers to addressing the current economic model and population growth need to be overcome. Strategic solutions proposed to the current neoliberal economy are generic – namely, degrowth, a steady-state economy, and a ‘circular economy’. Solutions to demographic issues must be sensitive to the countries' cultural, social, political and economic factors to be effective as fertility differs from country to country, and culture to culture. As discussed here, Mediterranean countries have the lowest fertility in the world, while many countries in Africa, and some in Asia, South America have stable but consistently high birthrates. This is discussed using three case studies - Tanzania, Italy, and Cambodia, focusing on the "best case" policy practice that offers more realistic hope for successful sustainability. https://doi.org/10.1007/s41207-019-0139-4 LinkedIn: https://www.linkedin.com/in/helenkopnina/
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Background In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands. Methods GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done. Findings GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04–1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63–1.19). HIV testing increased most among patients who were female and ≤19 or 50–64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01–1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05–1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97–0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing. Conclusions The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.
Background: Urban slums are characterised by unique challenging living conditions, which increase their inhabitants’ vulnerability to specific health conditions. The identification and prioritization of the key health issues occurring in these settings is essential for the development of programmes that aim to enhance the health of local slum communities effectively. As such, the present study sought to identify and prioritise the key health issues occurring in urban slums, with a focus on the perceptions of health professionals and community workers, in the rapidly growing city of Bangalore, India. Methods: The study followed a two-phased mixed methods design. During Phase I of the study, a total of 60 health conditions belonging to four major categories: - 1) non-communicable diseases; 2) infectious diseases; 3) maternal and women’s reproductive health; and 4) child health - were identified through a systematic literature review and semi-structured interviews conducted with health professionals and other relevant stakeholders with experience working with urban slum communities in Bangalore. In Phase II, the health issues were prioritised based on four criteria through a consensus workshop conducted in Bangalore. Results: The top health issues prioritized during the workshop were: diabetes and hypertension (non-communicable diseases category), dengue fever (infectious diseases category), malnutrition and anaemia (child health, and maternal and women’s reproductive health categories). Diarrhoea was also selected as a top priority in children. These health issues were in line with national and international reports that listed them as top causes of mortality and major contributors to the burden of diseases in India. Conclusions: The results of this study will be used to inform the development of technologies and the design of interventions to improve the health outcomes of local communities. Identification of priority health issues in the slums of other regions of India, and in other low and lower middle-income countries, is recommended.
PurposeSexuality and relationships education (SRE) often do not accommodate the needs of vulnerable young people in child and youth social care, (school) social work, and residential or foster care, leaving professionals in these fields a vital role in delivering SRE to these young people. This scoping review examines what competencies professionals need to facilitate adequate guidance and education about sexuality and relationships in their work with vulnerable children and young people.MethodsWe conducted a systematic literature search in five databases – PsychINFO, Eric, Medline, CINAHL and Social Services Abstracts – for articles published between 1991 and 2021 on March 6, 2021, using a set of predefined search strings. Articles on sexuality and relationship education (SRE) or sexual health, related to competencies of (future) professionals and published in English were included.ResultsOur review revealed a range of competencies that professionals may need, such as providing basic prevention, dealing with children struggling with their sexual orientation, handling disclosure of sexual abuse or dealing with problematic sexualized behavior (often combinations of the above), but also supporting young people in exploring positive aspects of relationships and sexuality.ConclusionSRE is an integral part of the work of professionals in child and youth social care. Wider organizational and educational commitment is needed for implementation of SRE to facilitate a safe environment for diverse young people.
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Background: In the Netherlands, general practitioners (GPs) play a key role in provider-initiated HIV testing, but opportunities for timely diagnosis are regularly missed. We implemented an educational intervention to improve HIV testing by GPs from 2015 to 2020, and observed a 7% increase in testing in an evaluation using laboratory data. The objective for the current study was to gain a deeper understanding of whether and how practices and perceptions of GPs’ HIV/sexually transmitted infection (STI) testing behaviour changed following the intervention. Methods: We performed a mixed-methods study using questionnaires and semi-structured interviews to assess self-reported changes in HIV/STI testing by participating GPs. Questionnaires were completed by participants at the end of the final educational sessions from 2017 through 2020, and participating GPs were interviewed from January through March 2020. Questionnaire data were analysed descriptively, and open question responses were categorised thematically. Interview data were analysed following thematic analysis methods. Results: In total, 101/103 participants completed questionnaires. Of 65 participants that were included in analyses on the self-reported effect of the programme, forty-seven (72%) reported it had changed their HIV/STI testing, including improved STI consultations, adherence to the STI consultation guideline, more proactive HIV testing, and more extragenital STI testing. Patients’ risk factors, patients’ requests and costs were most important in selecting STI tests ordered. Eight participants were interviewed and 15 themes on improved testing were identified, including improved HIV risk-assessment, more proactive testing for HIV/STI, more focus on HIV indicator conditions and extragenital STI testing, and tools to address HIV during consultations. However, several persistent barriers for optimal HIV/STI testing by GPs were identified, including HIV-related stigma and low perceived risk. Conclusions: Most GPs reported improved HIV/STI knowledge, attitude and testing, but there was a discrepancy between reported changes in HIV testing and observed increases using laboratory data. Our findings highlight challenges in implementation of effective interventions, and in their evaluation. Lessons learned from this intervention may inform follow-up initiatives to keep GPs actively engaged in HIV testing and care, on our way to zero new HIV infections.
