Serious health-related suffering experienced by children with disability and their families living in Bangladesh: A scoping review.

BACKGROUND: In 2020, the International Association for Hospice and Palliative Care redefined palliative care to incorporate the concept of serious health-related suffering. An estimated 21 million children globally live with conditions which would benefit from a palliative approach to relieve suffering. Bangladesh is a lower-middle income country with isolated provision of palliative care. AIM: To synthesise existing evidence describing serious health-related suffering of children with disability and their families living in Bangladesh and the intersection between this suffering, palliative care and rehabilitation. DESIGN: Scoping review methodology. DATA SOURCES: A search strategy related to serious health-related suffering and childhood disability was applied to online databases and grey literature. English language studies (1990-2021) were included. Papers pertaining to serious health-related suffering of typically developing children and those over eighteen years were excluded. Data which addressed the three domains of serious health-related suffering (physical, social and emotional/spiritual) were extracted. Palliative care interventions were assessed with a pre-existing checklist. RESULTS: Forty-six studies were included, representing ten different methodologies. Sample sizes ranged from 11 to 2582 participants, with 87% of studies including children with cerebral palsy. Serious health-related suffering was described in 100% of the studies, only 14 of the studies described specific interventions to mitigate suffering. Convergence between palliative care and rehabilitation approaches was evident. CONCLUSION: Findings document the extensive nature and burden of serious childhood health-related suffering that may be remediated by a palliative approach. They highlight the urgent need to prioritise service development and research in this area.

Can an increased copper requirement in copper-tolerant Mimulus guttatus explain the cost of tolerance? II. Reproductive phase.

Circumstantial evidence suggests that plants that have evolved metal tolerance are at a disadvantage on normal soil, i.e. there is a cost of tolerance. One hypothesis for the cause of this cost is that individuals have a greater requirement for copper, and so suffer micronutrient deficiency on normal soils, as a result of a reduced uptake, distribution and/or utilization of copper. We provided highly and less copper-tolerant plants of Mimulus guttatus Fischer ex DC. (the common monkey flower) with sub-optimal copper, and demonstrated the importance of copper as an essential micronutrient during the reproductive phase, both in the production of viable pollen and in seed set. We also looked at the effect of sub-optimal copper supply on the growth of the microgametophyte, and the efficiency with which seed was set. No evidence was found that highly tolerant plants have an increased copper requirement during the reproductive phase. This is in agreement with earlier work on Mimulus guttatus, which investigated the copper requirement of highly tolerant plants during vegetative growth and found that any differences in copper requirement were small. The 'metal requirement hypothesis' is, therefore, not the sole explanation for the cost of copper tolerance in M. guttatus.

Can an increased copper requirement in copper-tolerant Mimulus guttatus explain the cost of tolerance?: I. Vegetative growth.

If metal tolerant plants, by virtue of their tolerance mechanism, are less efficient at the uptake, distribution or utilization of metals then essential micronutrient deficiency may occur at the low levels of metal supply found on non-mine soils. This argument forms the basis of the metal requirement hypothesis put forward to explain the lower fitness of tolerant individuals on uncontaminated soil, the so called'cost of tolerance'. In this paper, copper balance was investigated in Mimulus guttatus Fischer ex. DC (the yellow monkey flower) for plants with or without the major tolerance gene which confers primary tolerance, and plants with few or many modifier genes which control degree of tolerance. No conclusive evidence to support an increased copper requirement in plants with the major tolerance gene, and/or many modifier genes was shown. Any differences in copper requirement found during vegetative growth were small, and were deemed insufficient to explain the apparent cost of tolerance.