A qualitative study of gutka and paan masala use among Bhutanese and Burmese migrants in Georgia

"My culture doesn't 100% like these kinds of services, but you decide what to do": Female refugees' experiences with sexual and reproductive healthcare in the Southeastern U.S

Objective

This study investigates female refugees' experiences accessing and utilizing sexual and reproductive (SRH) services in the state of Georgia.

Methods

We conducted in-person, in-depth semi-structured interviews with 26 female refugee adolescents and adults from Burma, Bhutan or Nepal, and the Democratic Republic of Congo living in Georgia. Questions inquired about perceptions and experiences while accessing and utilizing SRH services. Data were analyzed using thematic analysis.

Results

Participants discussed the importance but also varying influence of social and cultural norms on SRH service utilization. Challenges to accessing and utilizing SRH services included communication and cost barriers. Facilitators included accessible clinic locations, transportation, and positive interactions with clinic providers and staff.

Conclusion

Understanding female refugees' experiences accessing and utilizing SRH services is critical to meet their SRH needs adequately. Through community engagement, practitioners and researchers can gain insights into cultural influences on SRH, address communication and cost barriers, and enhance existing facilitators to increase female refugees' access and use of services.

Innovation

Our community-engaged study incorporated perspectives of diverse groups of refugee women and adolescents in the Southeastern U.S. Findings from this study highlight lived experiences with SRH services and identify barriers to and facilitators of SRH services access and utilization.

Metabolism of the areca alkaloids - toxic and psychoactive constituents of the areca (betel) nut

Areca nut (AN) is consumed by millions of people for its therapeutic and psychoactive effects, making it one of the most widely self-administered psychoactive substances in the world. Even so, AN use/abuse is associated with myriad oral and systemic side effects, affecting most organ systems in the body. Alkaloids abundant in the nut (e.g. arecoline, arecaidine, guvacoline, and guvacine), collectively called the areca alkaloids, are presumably responsible for the major pharmacological effects experienced by users, with arecoline being the most abundant alkaloid with notable toxicological properties. However, the mechanisms of arecoline and other areca alkaloid elimination in humans remain poorly documented. Therefore, the purpose of this review is to provide an in-depth review of areca alkaloid pharmacokinetics (PK) in biological systems, and discuss mechanisms of metabolism by presenting information found in the literature. Also, the toxicological relevance of the known and purported metabolic steps will be reviewed. In brief, several areca alkaloids contain a labile methyl ester group and are susceptible to hydrolysis, although the human esterase responsible remains presumptive. Other notable mechanisms include N-oxidation, glutathionylation, nitrosamine conversion, and carbon-carbon double-bond reduction. These metabolic conversions result in toxic and sometimes less-toxic derivatives. Arecoline and arecaidine undergo extensive metabolism while far less is known about guvacine and guvacoline. Metabolism information may help predict drug interactions with human pharmaceuticals with overlapping elimination pathways. Altogether, this review provides a first-of-its-kind comprehensive analysis of AN alkaloid metabolism, adds perspective on new mechanisms of metabolism, and highlights the need for future metabolism work in the field.