RESUMEN
Persistent organic pollutants (POPs) are organic chemical substances that threaten human health and the planet's ecosystems due to their toxicity and their ability to remain intact for a long time, wide distribution throughout the environment, and accumulation and magnification in living organisms through the food chain. Discarded products from landfills and dumpsites are potential sources of POPs due to their persistence for several decades and constant release to surrounding environment. POPs in aquatic systems signal input predominantly from landfills, wastewater treatment plants, sewage, and urban runoff, suggesting a research gap to guide policies to address these unabated releases. This scoping review aims to rapidly identify the key concepts underpinning the containment, translation, and migration of POPs in Canadian and US landfill leachate. The review targeted multidisciplinary perspectives on the topic and spanned forensic biology, environmental sciences, chemistry, and geology. Contaminated municipal solid waste (MSW) landfill characteristics, as reported by government agencies in Canada and the US, were synthesized and harmonized to illustrate the geographical scope of MSW landfills releasing POPs into the surrounding environment. The knowledge and data gaps summarized in this study highlight the need to address the inadvertent release of POPs from Canadian and US landfills, particularly in consideration of dated and degrading landfill infrastructure, the proximity of marginalized people, and the implications of climate change on the countries' more vulnerable landscapes. This review is applicable to the development of future studies that aim to guide environmental protective policies.
Asunto(s)
Eliminación de Residuos , Contaminantes Químicos del Agua , Humanos , Estados Unidos , Ecosistema , Contaminantes Orgánicos Persistentes , Canadá , Instalaciones de Eliminación de Residuos , Residuos Sólidos , Contaminantes Químicos del Agua/análisisRESUMEN
OBJECTIVE: Although many health care organizations have sought to increase the integration of substance use services into clinical practice, such practice changes can prove difficult to sustain. METHOD: Seven primary care clinics participated in an implementation study of screening and brief intervention (BI) services for adolescent patients (ages 12-17). All sites delivered screening and brief advice (BA) for low-risk use using a uniform protocol. Clinics were randomized to deliver BI using generalist (provider-delivered) or specialist (behavioral health clinician-delivered) models. Implementation was facilitated by multiple supporting activities (e.g., trainings, local "champion," electronic health record [EHR] integration of screening and documentation, individualized feedback, project-specific materials, etc.). Data on the penetration of screening, BA, and BI delivery (N = 14,486 adolescent patient visits) were abstracted from the EHR for the 20-month implementation phase and a 12-month sustainability phase (during which implementation supports were removed). RESULTS: Penetration of screening continued to slowly increase across the implementation-to-sustainability phases (62% vs. 70%; p = .04). Although uptake during implementation was low for BA (29%) and BI (22%), there was no significant decrease in service provision during the sustainability phase. Although overall delivery of BI was significantly higher in generalist compared with specialist sites (p < .001), sustainability did not differ by generalist versus specialist conditions. There were considerable differences in penetration across clinic sites. CONCLUSIONS: Clinics sustained a high level of substance use screening. Uptake of intervention services was low but did not decrease further following the cessation of implementation supports. This study illustrates the challenges of successfully implementing and sustaining substance use services in adolescent primary care.
Asunto(s)
Atención Primaria de Salud , Trastornos Relacionados con Sustancias , Humanos , Adolescente , Niño , Atención Primaria de Salud/métodos , Intervención en la Crisis (Psiquiatría) , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/terapia , Tamizaje Masivo/métodosRESUMEN
PURPOSE: Small bowel or multivisceral transplant is a relatively new treatment for irreversible intestinal damage, and no published practice guidelines exist. The purpose of this article is to report evidence regarding the best plan of care to achieve adequate nutrition and appropriate development for children. DESIGN AND METHODS: An integrative review was conducted with 54 articles related to management of this transplant population. A nine-member nursing team integrated the findings. PRACTICE IMPLICATIONS: This resulting guideline represents the best research and best practices on which to base staff education and competency validations to manage this medically fragile patient population.