Ineffective Interventions Research Articles

Understanding and tackling oral health inequalities in vulnerable adult populations: from the margins to the mainstream.

Vulnerable and socially excluded groups in society persistently experience significantly worse oral health and poorer access to dental services than the mainstream population. Action to tackle these unfair, unjust and avoidable inequalities in oral health needs to be informed by an understanding of the broad range of interacting factors that ultimately influence oral health across society and specifically the most vulnerable and marginalised. Failure to understand the underlying factors that create and perpetuate the oral health equity gap risks the development and implementation of ineffective interventions that do not achieve meaningful improvements in oral health for the most vulnerable. This paper presents a theoretical framework that combines a broad public health perspective on oral health inequalities, combined with more specific factors determining the oral health of vulnerable and marginalised groups. Actions to improve access to dental services and policies to combat oral health inequalities among vulnerable adult populations are then presented.

Linking habitat use to mortality and population viability to disarm an ecological trap

Animal excursions out of protected areas are a source of human-wildlife conflict and can lead animals into ecological traps. These arise when animals prefer areas of their habitat conferring lower fitness than other available areas. Ecological traps should become increasingly common as humans continue to alter habitats, yet their impact on population viability has rarely been documented and there is limited knowledge on how to disarm them. Moreover, although spatial factors such as the proportion of trap habitat in the landscape are crucial in determining the probability of extinction, few studies have attempted to link animal use of space to demography to obtain insights into how to release trapped populations. Here we tackle these gaps using a stochastic, spatially explicit matrix model parametrized with empirical data. We show that a free-ranging population of plains bison (Bison bison bison) caught in an ecological trap caused by legal but unregulated hunting has a 66% probability of extinction over the next 50 years under current conditions. By linking the time bison spent in fields with hunting permission to survival and population persistence, we show that bison use of such fields must decrease by 70% to ensure population viability. Our approach narrowed down the ecological trap to <1% of the population's range during the hunting period. Targeting this limited portion of the landscape would hence be a cost-effective strategy to disarm the trap. We show that a spatially explicit approach to demography can refine conservation strategies to avoid potentially onerous and ineffective interventions.

Exercise And Physical Activity Promotion Improves Cardiorespiratory Fitness, Symptoms Of Disease And Well-being In Patiens With Schizophrenia

Patients suffering from Schizophrenia (SZ) show low fitness, a sedentary lifestyle and comorbidities like diabetes and cardiovascular diseases, resulting in 20 years less of life expectancy. PURPOSE: To evaluate the impact of an intervention combining exercise and physical activity promotion (PAP) on cardiorespiratory fitness (CRF), severity of SZ, symptoms of disease and well-being. METHODS: 35 patients were randomized into an intervention (n=19, aged 39.0 ± 13.6 years, BMI 28.3 ± 7.3) or control group (n=16, aged 36.0 ± 9.3 years, BMI 25.7 ± 5.2), directly after inpatient treatment for SZ. Intervention included two sessions of high intensity indoor cycling (IC; each 45min), and one session of PAP (60min) per week for three months. In months 4-6, the intervention was reduced to one session IC and one session PAP per week. The control group received a physiologically ineffective control intervention. Measurements were conducted at baseline (t0), after three (t1) and 6 months (t2) of intervention, and after 12 months (six-month follow up, t3). Measurements included CRF (bicycle ergometry), severity of SZ (PANSS-Score), well-being (SF-36), and psychological distress (SCL-90). RESULTS: The intervention improved significantly severity of SZ (t0: 55.4 ± 16.3, t2: 34.8 ± 3.3, p<.05), well-being (t0: 50.4 ± 10.1, t2: 60.5 ± 7.1, p<.05) and psychological distress (t0: 159 ± 47.4, t2: 119.8 ± 34.3, p<.05). For CRF, patients were able to improve their physical capacity, expressed as W/kg (t0: 1.85 ± 0.6, t2: 2.13 ± 0.6, p<.05), but did not significantly improve their peak oxygen uptake, expressed as ml/min/kg (29.0 ± 7.0, t2: 30.5 ± 8.7, n.s.). Six month after the intervention, only improvements in severity of SZ, well-being and psychological distress remained statistically significant (PANSS: 38.0 ± 9.0, SF-36: 59.2 ± 8.0, SCL-90: 119.2 ± 36.6, all p<.05). CONCLUSION: Exercise and PAP significantly improves CRF, severity of SZ, well-being and psychological distress in SZ patients. Effects on CRF are declining shortly after the end of the intervention. We recommend the implementation of exercise and PAP into the post-acute care of SZ patients. Moreover, it is necessary to further strengthen the sustainability of effects with respect to CRF, in order to prevent fall-backs and health detriments caused by low physical fitness.

A natural experiment study of the effects of imprisonment on violence in the community.

One of the goals of imprisonment is to reduce violence1. Although imprisonment has risen dramatically since the 1970s, its effects on future violent crime are poorly understood2. This study's objective was to examine the effect of imprisonment on violent crime in the community among individuals on the policy margin between prison and probation sentences. Drawing on data from a population-based cohort of individuals convicted of a felony in Michigan between 2003 and 2006 (n = 111,110) and followed through June 2015, we compared the rates of commission of violent crime committed by individuals sentenced to prison with those of individuals sentenced to probation using a natural experiment based on the random assignment of judges to criminal cases. Being sentenced to prison had no significant effects on arrests or convictions for violent crimes after release from prison, but imprisonment modestly reduced the probability of violence if comparisons included the effects of incapacitation during imprisonment. These results suggest that for individuals on the current policy margin between prison and probation, imprisonment is an ineffective long-term intervention for violence prevention, as it has, on balance, no rehabilitative or deterrent effects after release.

Post-Modern Epidemiology: When Methods Meet Matter.

In the last third of the 20th century, etiological epidemiology within academia in high-income countries shifted its primary concern from attempting to tackle the apparent epidemic of noncommunicable diseases to an increasing focus on developing statistical and causal inference methodologies. This move was mutually constitutive with the failure of applied epidemiology to make major progress, with many of the advances in understanding the causes of noncommunicable diseases coming from outside the discipline, while ironically revealing the infectious origins of several major conditions. Conversely, there were many examples of epidemiologic studies promoting ineffective interventions and little evident attempt to account for such failure. Major advances in concrete understanding of disease etiology have been driven by a willingness to learn about and incorporate into epidemiology developments in biology and cognate data science disciplines. If fundamental epidemiologic principles regarding the rooting of disease risk within populations are retained, recent methodological developments combined with increased biological understanding and data sciences capability should herald a fruitful post–Modern Epidemiology world.

Self-Rated Health and Relative Socioeconomic Deprivation in the Palestinian Refugee Communities of Lebanon.

Most Palestinian refugees in Lebanon are marginalized as refugees, poor, and targets of discrimination. This study seeks to understand deprivation among these refugees through an exploration of the relationship between indicators of general health and economic deprivation. A nationally representative sample of 2501 Palestinian refugee households were randomly selected and surveyed in 2010. Social workers interviewed the homemaker in eachhousehold using a questionnaire on health, economic, and socio-demographic information. This data was analyzed to understand the associations between health and levels of deprivation. 31% of respondents reported poor health and nearly 52% of households had two or more poverty indicators. The logistic regression found each degree of deprivation associated with a 33% increase in poor health (OR 1.33; CI 1.20-1.47). This study suggests understanding deprivation among impoverished communities requires a nuanced approach. Generalizations about experiences of poverty will generate ineffective policy and intervention strategies.

Esophagectomy for End-Stage Achalasia

Treatment for achalasia of cardia is multidirectional nowadays and depends on several factors such as patient’s sex and age, type and stage of disease, co-morbidity and complications. However the treatment for end-stage achalasia is still controversial. Ones who advocate organ preservation surgery consider esophagectomy an ultima ration. These authors conceive that esophagectomy is too traumatic for benign disease with low progression. Esophagectomy as a first approach for end-stage achalasia is recommended by others authors who believe that progredient course of disease (nonreversible strongly dilated and atonic esophagus), debilitating dysphagia, regurgitation, aspiration syndrome and ineffective intervention in cardia make the extirpation of the esophagus necessary. Persistent degeneration of life quality and high possibility of such devastating symptoms as aspiration and esophageal cancer alongside with unacceptable results of myotomy raise questions on the effectiveness of the organ preservation surgery for end-stage achalasia

Research in Brief: Autonomous sensory meridian response: An ineffective long-term therapeutic intervention

Autonomous sensory meridian response (ASMR) is a sensory phenomenon characterised by a pleasant tingling sensation in the scalp that radiates throughout the body in response to specific triggers. Using self-reported measures, the current study sought to establish if regular ASMR elicitation over a one-week period bestowed significant improvements in mood in comparison to a mindfulness intervention and control group. Findings suggest ASMR is an ineffective long-term intervention for improving mood.

Impact of Bed Alarm Removal and Implementation of Hourly Rounding to Reduce Falls

Audible pressure bed and chair alarms in the post-acute and long-term setting (PA/LTC) have proven to be an ineffective intervention for reducing falls and in fact have met criteria as a physical restraint according to the Centers for Medicare and Medicaid Services. A.G. Rhodes Health and Rehab facility (AGR) is a 150-bed non-profit nursing organization situated in Atlanta, Georgia, committed to fall prevention. As a 2-pronged approach, AGR eliminated all pressure alarms from its facility and implemented a patient-centered hourly rounding policy among nursing staff. Fall rates were analyzed before and after pressure alarm removal and after the implementation of hourly rounding.

Have Welsh agri‐environment schemes delivered for focal species? Results from a comprehensive monitoring programme

AbstractAgri‐environment schemes (AES) have been criticized for being inadequately monitored and for not delivering the expected benefits to nature. Consequently, the Welsh Government funded a comprehensive programme of monitoring of AES between 2009 and 2012. The AES assessment focused on Tir Gofal (which translates as “Land in Care”) but also included the Organic Farming Scheme, and monitoring focused on a range of taxa of conservation importance: arable plants, grassland fungi, bats (six species), butterflies (three species), birds (five species), water vole and brown hare.Field surveys were carried out on matched farms and fields within and outside of AES. Response variables were spatial trends of abundance, occurrence and species richness, and were modelled against AES status. Existing data were also available for two bird species.Few differences were observed between AES and non‐AES farms and fields. Those that were observed were for species that use arable habitats (which are uncommon in Wales): arable plants, yellowhammers and brown hares. The lack of differences in non‐arable habitats may reflect the smaller contrast between AES and non‐AES management in these habitats. It may also reflect the original condition of habitat entered into AES prescriptions, as most non‐arable prescriptions were defined by mandatory management of existing habitats, rather than optional habitat creation or restoration, which is the case for most arable prescriptions.Despite the lack of differences observed, AES may help to maintain populations of species, making it more likely that they will persist in the landscape. There is evidence, from this monitoring programme and elsewhere, that AES can increase the populations of species, when well targeted and implemented.Policy implications. Our results indicate that Welsh Agri‐environment schemes (AES) have been only partly successful in achieving their stated aim of “maintaining and enhancing species abundance”. They can be used to improve AES design and management, both in Wales and more widely, by identifying and promoting effective management interventions, and by identifying ineffective management interventions and seeking alternatives. Comprehensive monitoring of AES, combined with specific targets regarding expected outcomes, is essential to determine whether AES are providing value for money.

How to improve the well-being of homeless girls: an exploratory study

ABSTRACTWorldwide, homeless girls are a highly vulnerable group. They suffer sexual exploitation and forced labor, discrimination, and social exclusion at a higher rate than the rest of the general population. They often present anxiety and depression, unassertiveness and emotion dysregulation, among other psychosocial characteristics. All of these factors negatively impact subjective well-being, further worsening their mental health. Subjective well-being has both immediate (mental health, health behaviors) and long-term, cumulative effects on health (physical health, mortality), representing opportunities for investment in population health. Despite the relevance of subjective well-being and its associated factors, there is scarce research on the plight of homeless girls in Mexico and Latin America, which leads to ineffective interventions, policy actions and to a diminished quality of life. This study was carried out to develop and test a path model of well-being in 240 Mexican homeless girls ages 6–23 years old. Symptoms of anxiety and depression, assertiveness and emotion regulation strategies were used as factors influencing subjective well-being. Results showed that symptoms of depression and functional emotion regulation strategies have a significant direct influence on subjective well-being. Symptoms of anxiety and dysfunctional emotion regulation strategies have an indirect influence on subjective well-being with symptoms of depression as the mediating variable. Assertiveness did not significantly influence well-being directly and indirectly. Functional and dysfunctional emotion regulation strategies have a positive significant correlation. Fit indexes obtained indicate an excellent adjustment to data. R square indicates that 38% of the variance in subjective well-being can be explained by this model. Hence, the current study provides unique findings in terms of a model of well-being through which it is possible to design and implement interventions that increase such well-being in order to promote healthier social and emotional developmental trajectories in homeless girls, especially in the context of Latin American cities.

AMA Code of Medical Ethics' Opinions Related to False Beliefs in Health Care.

Principle V, Opinion 1.1.6 ("Quality") and Opinion 5.5 ("Medically Ineffective Interventions") are explored here to briefly explain physicians' responsibilities when it comes to false or medically inappropriate interventions.

A multilevel analysis of contextual risk factors for intimate partner violence in Ghana

While extant research suggests that context, structural socioeconomic and cultural factors matter in intimate partner violence research, quantitative research on the subject in sub-Saharan Africa, and in particular Ghana, has disproportionately focused on prevalence and individual level correlates of spousal violence. This research has ignored the role of the structural socioeconomic and cultural factors and contexts in understanding the causes and consequences of spousal violence in a setting where family life is heavily influenced by traditional norms and beliefs. These norms and beliefs may lead to inadequate and ineffective interventions geared at preventing or reducing spousal violence and its consequences. Guided by an integrated theoretical approach, this study addresses these issues by estimating a multilevel logistic regression model where the effects of both individual and community level risk factors for spousal violence are assessed. Data for the study come from the Ghana Demographic and Health Survey and the Ghana Population and Housing Census. The findings confirm the salient role of structural socioeconomic and cultural factors, such as patriarchal norms and residential instability, in the perpetration of spousal violence against women. Policy implications of these findings and directions for further research are discussed.

EUS-Guided Coil Embolization with Absorbable Hemostatic Gelatin Sponge vs. Cyanoacrylate Injection for Treatment of Gastric Varices: Comparison of Clinical Outcomes and Health Care Utilization Presidential Poster Award

Introduction: Gastric variceal bleeding is an uncommon complication of cirrhosis but is associated with high rates of mortality and morbidity. Traditional endoscopic treatment options involve cyanoacrylate (CYA) injection which can be technically challenging. Coil embolization and absorbable gelatin sponge (Gelfoam®) are frequently used by interventional radiology for hemostasis. Recently, we have applied this combination therapy in EUS-guided management of gastric varices (GV) with high therapeutic success. We compared the outcome and health care utilization of endoscopic coil embolization with Gelfoam therapy versus CYA injection for treatment of GV.542_A Figure 1. Demographics and Patient Characteristics. Data are presented as number of cases (percentage) OR mean ± S.D. [ ] signify range of values. Abbreviations: NAFLD = non-alcoholic fatty liver disease; MELD = Model for End-stage Liver Disease; IGV = isolated gastric varices; GOV = gastroesophageal varices; UGIB = upper gastrointestinal bleed.542_B Figure 2. Comparison of Primary and Secondary Outcomes. *Two patients passed away prior to adequate follow-up evaluation of need for re-intervention (both due to HCC progression). Data are presented as number of cases (percentage) OR mean ± S.D. [ ] signify range of values. Abbreviations: CYA = cyanoacrylate; BRTO = balloon-occluded retrograde transvenous obliteration; HCC = hepatocellular carcinoma; HD = hemodynamic.Methods:Study Design: Matched cohort study using a prospective registry of over 10 yearsMatching: 5 consecutive patients undergoing EUS coil embolization with Gelfoam therapy for bleeding GV (10/2017-6/2018) were matched in 1:4 fashion to 20 patients who underwent cyanoacrylate injection. Matching criteria included age, Child-Pugh class, variceal type, and bleeding severity on admission. Primary outcome: Need for re-intervention at 3 months Secondary outcomes: All-cause mortality at 3 months, time spent in hospital post procedure, and post-procedural transfusion requirements Statistics: Student t-test and Fisher's exact test Results: 0% (0/5) patients in the coil embolization with Gelfoam cohort required re-intervention at 3-months, as compared to 56% (10/18) in the CYA cohort (p=0.046). Mortality at 3 months was 0% (0/5) for coil with Gelfoam versus 20% (4/20) for CYA (p=0.55), with 1 death directly attributed to ineffective intervention and uncontrolled GV bleeding. Post procedural hospitalization was higher for the CYA cohort (8.6±9.9 vs. 3.4±2.2 days; p=0.26). Post procedure transfusion requirements on average was higher for the CYA cohort (1.95±2.70 vs. 0.2±0.4 units of blood; p=0.17). Conclusion: EUS guided coil embolization with absorbable gelatin sponge therapy is a novel technique that appears to be highly effective in treating bleeding gastric varices. This technique lend itself to effective and sustained hemostasis compared to cyanoacrylate injection which requires re-intervention. There was a trend toward significance with post-procedural time spent in the hospital and transfusion requirements; larger studies in the future should help elucidate additional benefits and risks from this novel approach.

Linking Antimicrobial Resistance Surveillance Data to Provincial Hospital Records: A Descriptive Study of Patient and Facility-level Characteristics

IntroductionAntimicrobial resistance (AMR) is an emerging phenomenon where microorganisms develop resistance against treatment antimicrobials, resulting in ineffective clinical interventions. The recent development of AMR surveillance systems at global and national stages highlights the growing importance of this topic from a public health perspective.&#x0D; Objectives and ApproachThe objective was to link standardized population-based hospital AMR surveillance data with hospitalizationrecords to inform patient safety practices in Alberta, Canada. Incident inpatient cases of Methicillin-Resistant Staphylococcus aureus (MRSA),identified by Alberta Health Services Provincial Infection Prevention and Control(IPC) Surveillance from five acute care facilities in the Calgary zone (April 2011 to March 2016),were deterministically linked to the Discharge Abstract Database using Provincial Healthcare Number and gender. The incident cohort was stratified into hospital-acquired (HA-MRSA) and community-acquired MRSA (CA-MRSA) cases. Descriptive statistics were used to describe the patient outcomes and facility characteristics of these two groups.&#x0D; ResultsA total of 2550 unique patients, representing 93.5% of the surveillance cohort, were successfully linked to hospitalization records. A total of 1259 patients belonged to HA-MRSA categories and 1291 patients belonged to CA-MRSA categories. Patients with HA-MRSA had longer hospital stays, were older, were more likely to have prior hospitalizations, had higher Charlson Comorbidity Scores, and were more likely to die in hospital when compared to patients with CA-MRSA. HA-MRSA results emphasized the important roles of in-hospital patient safety practices whereas CA-MRSA results alluded to the impact of community public health and primary care services onthe risk of hospitalization, although detected CA-MRSA numbers were likely underestimated due to selection bias within our linked cohort.&#x0D; Conclusion/ImplicationsThis is first Canadian study describing HA-MRSA and CA-MRSA using linked population databases. It offers a glimpse into the intricate relationship between patient health and our healthcare system. This knowledge represents an important step forwarding building IPC strategies for managing AMR and improving outcomes in Alberta and in Canada.

Simulation of Shoulder Dystocia for Skill Acquisition and Competency Assessment: A Systematic Review and Gap Analysis.

Mastery of shoulder dystocia management skills acquired via simulation training can reduce neonatal brachial plexus injury by 66% to 90%. However, the correlation between simulation drills and reduction in clinical injuries has been inconsistently replicated, and establishing a causal relationship between simulation training and reduction of adverse clinical events from shoulder dystocia is infeasible due to ethical limitations. Nevertheless, professional liability insurance carriers increasingly are mandating simulation-based rehearsal and competency assessment of their covered obstetric providers' shoulder dystocia management skills-a high-stakes demand that will require rapid scaling up of access to quality shoulder dystocia simulation. However, questions remain about differing simulation training schemes and instructional content used among clinically effective and ineffective educational interventions. This review of original research compares curricular content of shoulder dystocia simulation and reveals several critical gaps: (1) prescriptive instruction prioritizing maneuvers shown to decrease strain on the brachial plexus is inconsistently used. (2) Proscriptive instruction to avoid placing excessive and laterally directed traction on the head or to observe a brief hands-off period before attempting traction is infrequently explicit. (3) Neither relative effectiveness nor potential interaction between prescriptive and proscriptive elements of instruction has been examined directly. (4) Reliability of high-fidelity mannequins capable of objective measurement of clinician-applied traction force as compared with subjective assessment of provider competence is unknown. Further study is needed to address these gaps and inform efficient and effective implementation of clinically translatable shoulder dystocia simulation.

Euphorbia factor L2 alleviates lipopolysaccharide-induced acute lung injury and inflammation in mice through the suppression of NF-κB activation

Acute respiratory distress syndrome threatens public health with high morbidity and mortality due to ineffective intervention whereby lipopolysaccharide (LPS) induced acute lung injury (ALI) in mice provides a research model. The seeds of Euphorbia lathyris L. have a long history of usage in Traditional Chinese Medicine. Euphorbia factors L1-L11, extracted from this herb, have been reported to have anti-inflammation and anti-cancer effects. Here, we report the preventive and therapeutic potential of Euphorbia factor L2 (EFL2) on LPS-induced ALI in mice, where EFL2 attenuated pathological alterations in the lung and improved survival. Significant suppression of the recruitment and transmigration of inflammatory cells, specifically neutrophils, by 40 mg/kg of EFL2 was observed. EFL2 exerted potent anti-inflammatory effects by decreasing the levels of interleukin-1β (IL-1 β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α), interleukin-8 (IL-8) and myeloperoxidase (MPO) in the lung and bronchioalveolar lavage fluid. Consistent with the findings in vivo, EFL2 also showed robust inhibitory effects on the production of IL-1 β, IL-6, TNF- α and IL-8 released from LPS-stimulated RAW264.7 cells in vitro. Interestingly, this effect appeared to be mediated by EFL2’s inhibition of NF-κB signaling activation, but not the MAPK pathway. Not only phosphorylation of IKK α/β and IκBα was down-regulated, p65 translocation and its DNA-binding activity were also significantly suppressed by EFL2. Moreover, overexpression of p65 reversed the inhibitory effect of EFL2 in LPS-induced NF-κB activation and cytokines production. The observed anti-inflammatory bioactivity of EFL2 indicates its potential as a drug development candidate, particularly for LPS-mediated disorders of inflammation.

Towards a biomarker model for cognitive improvement: No change in memory-related prefrontal engagement following a negative cognitive remediation trial in bipolar disorder

Cognitive deficits are prevalent in bipolar disorder during remission but effective cognition treatments are lacking due to insufficient insight into the neurobiological targets of cognitive improvement. Emerging data suggest that dorsal prefrontal cortex target engagement is a key neurocircuitry biomarker of pro-cognitive treatment effects. In this randomized controlled functional magnetic resonance imaging study, we test this hypothesis by investigating the effects of an ineffective cognitive remediation intervention on dorsal prefrontal response during strategic memory encoding and working memory engagement. Bipolar disorder patients in partial remission with subjective cognitive difficulties were randomized to receive 12-week group-based cognitive remediation ( n = 13) or to continue their standard treatment ( n = 14). The patients performed a strategic episodic picture encoding task and a spatial n-back working memory task under functional magnetic resonance imaging at baseline and following cognitive remediation or standard treatment. The right dorsolateral prefrontal cortex was commonly activated by both strategic memory tasks across all patients. The task-related prefrontal engagement was not altered by cognitive remediation relative to standard treatment. The dorsolateral prefrontal cortex response was not significantly associated with recall accuracy or working memory performance. As hypothesized, no task-related change in prefrontal activity was observed in a negative cognitive remediation trial in remitted bipolar disorder patients. By complementing previous findings linking cognitive improvement with increased dorsolateral prefrontal cortex engagement, our negative findings provide additional validity evidence to the dorsal prefrontal target engagement biomarker model of cognitive improvement by strengthening the proposed causality between modulation of dorsolateral prefrontal cortex engagement and pro-cognitive effects.

Older adult\u2019s experience of chronic low back pain and its implications on their daily life: Study protocol of a systematic review of qualitative research

BackgroundOf various chronic diseases, low back pain (LBP) is the most common and debilitating musculoskeletal condition among older adults aged 65 years or older. While more than 17 million older adults in the USA suffer from at least one episode of LBP annually, approximately six million of them experience chronic LBP that significantly affects their quality of life and physical function. Since many older adults with chronic LBP may also have comorbidities and are more sensitive to pain than younger counterparts, these older individuals may face unique age-related physical and psychosocial problems. While some qualitative research studies have investigated the life experiences of older adults with chronic LBP, no systematic review has integrated and synthesized the scientific knowledge regarding the influence of chronic LBP on the physical, psychological, and social aspects of lives in older adults. Without such information, it may result in unmet care needs and ineffective interventions for this vulnerable group. Therefore, the objective of this systematic review is to synthesize knowledge regarding older adults’ experiences of living with chronic LBP and the implications on their daily lives.Methods/designCandidate publications will be sought from databases: PubMed, CINAHL, and PsycINFO. Qualitative research studies will be included if they are related to the experiences of older adults with chronic LBP. Two independent reviewers will screen the titles, abstracts, and full-text articles for eligibility. The reference lists of the included studies will be checked for additional relevant studies. Forward citation tracking will be conducted. Meta-ethnography will be chosen to synthesize the data from the included studies. Specifically, the second-order concepts that are deemed to be translatable by two independent reviewers will be included and synthesized to capture the core of the idiomatic translations (i.e., a translation focusing on salient categories of meaning rather than the literal translation of words or phrases).DiscussionThis systematic review of qualitative evidence will enable researchers to identify potential unmet care needs, as well as to facilitate the development of effective, appropriate, person-centered health care interventions targeting this group of individuals.Systematic review registrationPROSPERO 2018: CRD42018091292

“It was totally different than what we had before”: Perceptions of urban militarism under Rio de Janeiro’s Pacifying Policing Units

Scholars argue that military ideologies, discourses, and practices are increasingly deployed in poor urban areas to control populations deemed “dangerous.” However, very little research exists to document how residents in targeted neighborhoods experience these security interventions. This article addresses this gap by considering the case of Rio de Janeiro’s UPP Program, wherein the military police occupied several of Rio de Janeiro’s favelas, or low-income marginalized neighborhoods. The intervention began in 2008 and aimed to expel drug traffickers who had controlled these areas since the 1970s and install permanent policing precincts. While many studies suggest that the urban poor tend to reject aggressive policing practices, the UPP received widespread approval by favela residents in the first years of the occupation. This article draws upon ethnographic fieldwork conducted in the City of God, one of the first neighborhoods occupied by the UPP, to examine the factors underlying residents’ positive assessment of the UPP. I found that support for the UPP hinged on (a) its deviation from the brutal and ineffective military interventions deployed in the past; (b) the UPP’s ability to subdue violent drug traffickers and restore public security; (c) state investments in social services and resources attributed to the occupation; and (d) the race, gender, and age profiles of participants, wherein women, the elderly, and lighter-skinned residents reported greater approval for the UPP than young Black men. Ultimately, these findings suggest that variability between security interventions, their impact on public security and social development, and demographic diversity within targeted neighborhoods must be considered if we are to fully understand how the urban poor experience militarized security interventions.