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Kiepek N. Occupation in the Anthropocene and Ethical Relationality. Can J Occup Ther 2024; 91:44-55. [PMID: 37072931 PMCID: PMC10903124 DOI: 10.1177/00084174231169390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Purpose. Occupations have "implications for individuals, societies, and the earth". This article focusses on implications of occupation in relation to the earth and examines the potential to expand occupational justice beyond anthropocentric viewpoints to honour interspecies justice. Approach. A 'theory as method' approach is used to explore the literature. Transgressive decolonial hermeneutics informs analysis. Key issues. The discussion advances understandings about human occupation in relation to more-than-humans, intersections with human occupations and animals, and ethical relationality. Implications. Occupational justice includes honouring interdependence of species, engaging in occupations in ways that are sustainable, considering future generations, and refraining from occupations that have a destructive or detrimental impact on the earth and more-than-humans. The profession has a collective responsibility to honour Indigenous worldviews and Indigenous sovereignty, recognising and welcoming the potential for Western conceptualisations of occupation to be transformed.
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Lala R. A Critical Understanding of Inclusion in Oral Microbiome Research through the Lens of Racial Capitalism. Community Dent Health 2024; 41:70-74. [PMID: 38533922 DOI: 10.1922/cdh_iadr24lala06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
There are important calls for greater inclusion of Indigenous and racialised communities in oral microbiome research. This paper uses the concept of racial capitalism (the extractive continuity of colonialism) to critically examine this inclusion agenda. Racial capitalism explicitly links capitalist exploitations with wider social oppressions e.g., racisms, sexism, ableism. It is not confined to the commercial sector but pervades white institutions, including universities. By using the lens of racial capitalism, we find inclusion agendas allow white institutions to extract social and economic value from relations of race. Racially inclusive research is perceived as a social good, therefore, it attracts funding. Knowledge and treatments developed from research create immense value for universities and pharmaceutical companies with limited benefits for the communities themselves. Moreover, microbiome research tends to drift from conceptualisations that recognise it as something that is shaped by the social, including racisms, to one that is determined genetically and biologically. This location of problems within racialised bodies reinforces racial oppressions and allows companies to further profit from raciality. Inclusion in oral microbiome research must consider ways to mitigate racial capitalism. Researchers can be less extractive by using an anti-racism praxis framework. This includes working with communities to co-design studies, create safer spaces, giving marginalised communities the power to set and frame agendas, sharing research knowledges and treatments through accessible knowledge distributions, open publications, and open health technologies. Most importantly, inclusion agendas must not displace ambitions of the deeper anti-oppression social reforms needed to tackle health inequalities and create meaningful inclusion.
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Affiliation(s)
- R Lala
- Population Health, School of Medicine and Population Health, University of Sheffield, UK
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Perkins J, Nelson S, Birley E, Mcswiggan E, Dozier M, McCarthy A, Atkins N, Agyei-Manu E, Rostron J, Kameda K, Kelly A, Chandler C, Street A. Is qualitative social research in global health fulfilling its potential?: a systematic evidence mapping of research on point-of-care testing in low- and middle-income contexts. BMC Health Serv Res 2024; 24:172. [PMID: 38326871 PMCID: PMC10848363 DOI: 10.1186/s12913-024-10645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Qualitative social research has made valuable contributions to understanding technology-based interventions in global health. However, we have little evidence of who is carrying out this research, where, how, for what purpose, or the overall scope of this body of work. To address these questions, we undertook a systematic evidence mapping of one area of technology-focused research in global health, related to the development, deployment and use of point-of-care tests (POCTs) for low-and middle-income countries (LMICs). METHODS We conducted an exhaustive search to identify papers reporting on primary qualitative studies that explore the development, deployment, and use of POCTs in LMICs and screened results to identify studies meeting the inclusion criteria. Data were extracted from included studies and descriptive analyses were conducted. RESULTS One hundred thirty-eight studies met our inclusion criteria, with numbers increasing year by year. Funding of studies was primarily credited to high income country (HIC)-based institutions (95%) and 64% of first authors were affiliated with HIC-based institutions. Study sites, in contrast, were concentrated in a small number of LMICs. Relatively few studies examined social phenomena related to POCTs that take place in HICs. Seventy-one percent of papers reported on studies conducted within the context of a trial or intervention. Eighty percent reported on studies considering POCTs for HIV and/or malaria. Studies overwhelmingly reported on POCT use (91%) within primary-level health facilities (60%) or in hospitals (30%) and explored the perspectives of the health workforce (70%). CONCLUSIONS A reflexive approach to the role, status, and contribution of qualitative and social science research is crucial to identifying the contributions it can make to the production of global health knowledge and understanding the roles technology can play in achieving global health goals. The body of qualitative social research on POCTs for LMICs is highly concentrated in scope, overwhelmingly focuses on testing in the context of a narrow number of donor-supported initiatives and is driven by HIC resources and expertise. To optimise the full potential of qualitative social research requires the promotion of open and just research ecosystems that broaden the scope of inquiry beyond established public health paradigms and build social science capacity in LMICs.
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Affiliation(s)
- Janet Perkins
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD, Scotland, UK.
| | - Sarah Nelson
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Emma Birley
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Emilie Mcswiggan
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Marshall Dozier
- Library Academic Support Team, Library & University Collections, and Information Services University of Edinburgh, Argyle House, 3 Lady Lawson Street, Edinburgh, EH3 9DR, Scotland, UK
| | - Anna McCarthy
- Department of Social Work, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD, Scotland, UK
| | - Nadege Atkins
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Eldad Agyei-Manu
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Jasmin Rostron
- Centre for Population Health Sciences, Old Medical School, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Koichi Kameda
- Centre Population et Développement (CEPED), 45 Rue Des Saints-Pères, 75006, Paris, France
| | - Ann Kelly
- Department of Global Health and Social Medicine, King's College London, Bush House North East Wing, 30 Aldwych, London, WC2B 4BG, England, UK
| | - Clare Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, England, UK
| | - Alice Street
- Department of Social Anthropology, School of Social and Political Science, University of Edinburgh, Chrystal Macmillan Building, 15a George Square, Edinburgh, EH8 9LD, Scotland, UK
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Crichton L, Daniels K, Merrylees N, Mukanyangezi MF, Sonkwe HM, Nduwayezu R, Thomson E. Teaching Scottish medical students about global health in partnership with LMIC institutions. Does it change their views on volunteering in LMIC settings? BMC Med Educ 2024; 24:65. [PMID: 38229034 DOI: 10.1186/s12909-024-05034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
CONTEXT An elective placement is a core part of most United Kingdom (UK) medical degrees, and a significant proportion of students choose to pursue their elective in low- and middle-income countries (LMIC). There is a risk that students are ill-prepared for some of the ethical challenges that they will face during these placements, and that they have little appreciation for some of the negative effects that their placement can have on the host healthcare system. This study sought to address some of these negative consequences by exploring the preparation of medical students for these experiences, and the effect of including the LMIC perspective in preparation materials. METHODS This qualitative study used thematic analysis to explore the attitudes of final year medical students at a Scottish medical school to international volunteering, after completing a module on global health. This module was designed and delivered in partnership with academics from Malawi, Rwanda and Zambia, thus incorporating a strong LMIC perspective. FINDINGS This study demonstrated the ability of a global health module with a strong LMIC perspective to influence the attitudes of final year medical students in the following ways: 1) Challenging assumptions around international volunteering and, in particular, around some of the negative effects of international volunteering that had not previously been considered. 2) Changing future practice around international volunteering. IMPLICATIONS This study provides good evidence that having a strong LMIC voice in preparation materials for medical students embarking on LMIC electives has the ability to increase awareness of some of the potential harms, and to positively influence how they plan to have discussions around and approach such experiences in the future.
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Affiliation(s)
| | - Katy Daniels
- School of Medicine, University of Dundee, Dundee, Scotland
| | - Neil Merrylees
- School of Medicine, University of Dundee, Dundee, Scotland
| | | | | | | | - Emma Thomson
- Kamuzu University of Health Sciences, Blantyre, Malawi.
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Neville P. Decolonising dental educational research: reflections from a white researcher. Adv Health Sci Educ Theory Pract 2023; 28:1679-1695. [PMID: 37074593 PMCID: PMC10113732 DOI: 10.1007/s10459-023-10228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Abstract
While there is an emerging scholarship on decolonising dentistry, the debate about reflexivity, positionality and white privilege in dental educational research and practice is still at a developmental stage. This article aims to contribute to this nascent debate by contemplating the question- is it appropriate, or possible, for a white researcher to undertake decolonisation work in dental education? If so, what would it entail or 'look' like? To answer this important question, the author offers a reflective account of their ethical and epistemological journey with this very question. This journey begins with how I, a white researcher, first became aware of the everyday racism experienced by my racially and ethnically minoritized students, the whiteness of dental educational spaces and how my white privilege and position as a dental educator consciously and unconsciously implicated me in these processes of exclusion and discrimination. While this revelation led to a personal commitment to do better in my practice, both as an educator and a researcher, I continue to struggle with my white ignorance and white fragility as I strive to make my work more inclusive. To illustrate this, I discuss an ethnodrama project on everyday racism that I lead on and how, despite choosing a more democratic research method, hegemonic whiteness continued to make its presence felt through my 'going it alone' method of work. This reflective account reaffirms that regular and routine self-reflection is key to ensuring that racialised inappropriate and damaging assumptions, frameworks of thinking, and ways of working are checked for. However, my praxis won't evolve through critical introspection alone. I need to be open to making mistakes, educating myself about racism and anti-racist practice, asking for help and guidance from my minoritized colleagues and more importantly, committing to working with people from minoritized communities rather than on them.
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Affiliation(s)
- Patricia Neville
- University of Bristol, Bristol, UK.
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
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Hird C, David-Chavez DM, Gion SS, van Uitregt V. Moving beyond ontological (worldview) supremacy: Indigenous insights and a recovery guide for settler-colonial scientists. J Exp Biol 2023; 226:jeb245302. [PMID: 37366314 DOI: 10.1242/jeb.245302] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Greater engagement and representation of Indigenous voices, knowledges and worldviews in the biological sciences is growing globally through efforts to bring more Indigenous academics into scientific research and teaching institutions. Although the intentions of such efforts may be admirable, these spaces often become sites of great personal tension for the Indigenous scholars who must 'bridge' or 'facilitate' a dialogue between Indigenous and settler-colonial (predominantly Western) knowledge traditions and worldviews. We are a small collective of early career Indigenous scholars from Australia, the United States and Aotearoa New Zealand, and we have gained insights into this situation through the unique experiential learning afforded by navigating such tensions. Here, we discuss tensions that bear remarkable similarities across geographies, cultures and settler-colonial contexts. In doing so, we aim to support other Indigenous scientists and scholars navigating settler-colonial and Western research institutions, while offering guidance, suggestions and reflections for the scientific community to allow the development of more nuanced strategies to support Indigenous academics than simply increasing Indigenous representation. We imagine transformed, innovative research and teaching agendas where Indigenous knowledges can thrive, and Indigenous scientists can apply themselves with mutual and balanced respect and reciprocity.
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Affiliation(s)
- Coen Hird
- School of Biological Sciences, The University of Queensland, Brisbane 4072, Queensland, Meeanjin, Australia
| | - Dominique M David-Chavez
- Department of Forest and Rangeland Stewardship, Colorado State University, Fort Collins, CO 80523, USA, located on Nunt'zi (Ute), Hinono'eino' (Arapaho) and Tsistsistas (Cheyenne) traditional homelands
| | - Shanny Spang Gion
- College of Natural Resources, University of Idaho, Moscow, ID 83844, USA, located on Nimiipu (Nez Perce), Palus (Palouse) and Schitsu'umsh (Coeur d'Alene) homelands
| | - Vincent van Uitregt
- School of Geography, Environment and Earth Sciences, Te Herenga Waka Victoria University of Wellington, Wellington 6012, Aotearoa, New Zealand
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Beresford P, Rose D. Decolonising global mental health: The role of Mad Studies. Glob Ment Health (Camb) 2023; 10:e30. [PMID: 37854430 PMCID: PMC10579658 DOI: 10.1017/gmh.2023.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/27/2023] [Accepted: 05/05/2023] [Indexed: 10/20/2023] Open
Abstract
In recent years, there has been a growing and high-profile movement for 'global mental health'. This has been framed in 'psych system' terms and had a particular focus on what has come to be called the 'Global South' or 'low and middle-income countries'. However, an emerging 'Mad Studies' new social movement has also developed as a key challenge to such globalising pressures. This development, however, has itself both being impeded by some of the disempowering foundations of a global mental health approach, as well as coming in for criticism for itself perpetuating some of the same problems as the latter. At the same time, we are also beginning to see it and related concepts like the UNCRPD being given new life and meaning by Global South activists as well as Global North activists. Given such contradictions and complexities, the aim of this paper is to offer an analysis and explore ways forward consistent with decolonizing global mental health and addressing madness and distress more helpfully globally, through a Mad Studies lens.
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Affiliation(s)
- Peter Beresford
- School of Health Science, University of East Anglia, Norwich, UK
- Shaping Our Lives, London, UK
| | - Diana Rose
- CASS and Sociology, Australian National University, Canberra, ACT, Australia
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Ogundipe A, Hylton D, Alexander P. Inclusion of cultural competence and racial awareness in nursing education: An exploration of the nurse educator role. Nurse Educ Today 2023; 120:105611. [PMID: 36327878 DOI: 10.1016/j.nedt.2022.105611] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/07/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Avanelle Ogundipe
- Division of Children's Nursing, Institute of Health & Social Care, London South Bank University, United Kingdom of Great Britain and Northern Ireland.
| | - Deborah Hylton
- Division of Children's Nursing, Institute of Health & Social Care, London South Bank University, United Kingdom of Great Britain and Northern Ireland
| | - Patricia Alexander
- Division of Social Work and Public Health, Institute of Health & Social Care, London South Bank University, United Kingdom of Great Britain and Northern Ireland
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Lokugamage AU, Robinson N, Pathberiya SDC, Wong S, Douglass C. Respectful maternity care in the UK using a decolonial lens. SN Soc Sci 2022; 2:267. [PMID: 36531139 PMCID: PMC9734803 DOI: 10.1007/s43545-022-00576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Respectful maternity care (RMC) is part of a global movement addressing the previous absence of human rights in global safe maternal care guidance. RMC is grounded in kindness, compassion, dignity and respectful working conditions. The decolonisation movement in healthcare seeks to dismantle structural biases set up from a historically white, male, heteronormative Eurocentric medical system. This article applies a decolonising lens to the RMC agenda and examines barriers to its implementation in UK healthcare systems. Searches of peer-reviewed journals about decolonising maternity care in the UK revealed little. Drawing from wider information bases, we examine power imbalances constructed throughout a history of various colonial biases yet lingering in maternity care. The overarching findings of our analysis revealed 3 areas of focus: professional structures and institutional biases; power imbalances between types of staff and stakeholders of care; and person-centred care through a decolonial lens. To uproot inequity and create fairer and more respectful maternity care for women, birthing people and staff, it is vital that contemporary maternity institutions understand the decolonial perspective. This novel enquiry offers a scaffolding to undertake this process. Due to significant differences in colonial history between Western colonising powers, it is important to decolonise with respect to these different territories, histories and challenges.
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Affiliation(s)
| | - Nathan Robinson
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
| | | | - Sarah Wong
- Present Address: UCL Medical School, University College London, 74 Huntley St, London, WC1E 6DE UK
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Ajibade BO, Hayes C. Using LEGO® Serious Play® Methodology in supporting Nigerian nursing students' sociocultural transitions to UK higher education: A phenomenological research study. Nurse Educ Today 2022; 119:105582. [PMID: 36191364 DOI: 10.1016/j.nedt.2022.105582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION From an historical perspective the United Kingdom (UK) has been the first European country of choice for Nigerian students wishing to study overseas. As an international contingent, Nigerian students continue to represent the UK's third largest international student body. This paper provides an insight into research undertaken to examine students' capacity to transition into the UK Higher Education system from a sociocultural perspective. Across the UK Higher Education Institutions (HEI's) have addressed issues surrounding internationalisation and decolonisation of the portfolio of programmes available to overseas students, with strategic curriculum design and justification processes evident in the extant literature. This project uses an innovative approach for the facilitation of dialogue with international students about their experiences of transitioning into UK systems of learning and teaching using a social constructivism approach. AIMS The aim of the research was to explore sociocultural perspectives which impacted on self-reported transitions to UK HEI's by Nigerian students. The objectives of the study were to a) provide a reflective lens of perspective on international student transitioning experiences for HEIs, educators and policymakers b) illuminate the challenges and barriers faced by Nigerian students during their transition from Nigerian to UK HE systems and infrastructures and c) to co-construct authentic and pragmatic knowledge of how best Nigerian students can be supported in their transition to UK HEI's. METHODS Smith (2010) interpretive phenomenological analysis, integrating qualitative research methods was implemented as a means of undertaking research facilitated using LEGO® Serious Play® Methodology as an innovative method of data collection. Twenty participants were recruited purposively to the study from an annual cohort of nursing students at a satellite Higher Education Institution (HEI) campus in Metropolitan city. Quirkos was used as a software package in analysing the data and establishing the salience as well as the commonality of emergent themes. RESULTS Findings reveal the extent to which sociocultural acclimation is of importance in the process of transition to UK HEIs. The perception of complex ambiguity surrounding the design and delivery of UK academic curricula was also reported as challenging by Nigerian students. Self-reported comments from Nigerian nursing students revealed the priori existence of negative learning experience, including lack of IT facilities, culturally rooted family expectations and responsibilities which then influenced perceptions and experiences of learning and teaching in the UK. Negative experiences included perceptions of racism regarding skin colour, fashion sense and UK practice focused on authentic assessment opportunities. CONCLUSION The small purposive sample of participants who engaged in this study, illuminated that students' prior experiences have the potential to influence their current pedagogical experience, in accordance with the principles of social constructivism. Most participants reported their experience of the transition period of entry to UK education varied between individuals, perhaps most significantly that perceptions of acculturation, acclimatisation and overall transition to the UK took between four and six months for a programme that may only have one year's duration.
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Affiliation(s)
- Benjamin O Ajibade
- Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK.
| | - Catherine Hayes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, UK
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Lala R. The Case for Decolonising the Dental Curricula in the UK. Community Dent Health 2022; 39:143-148. [PMID: 35543461 DOI: 10.1922/cdh_iadr22lala06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Students across disciplines in UK universities are demanding decolonisation of their education. These demands aim to resist the white European colonial endeavour that create racist inequalities. To address racial inequalities, the dental discipline has predominantly focused on diversity rather than decolonisation. By using two inter-related referents of decolonisation to dental caries and cosmetic dentistry, this article demonstrates the epistemic violence exerted through the objective hierarchised knowledge practices in dentistry. First, by starting from the position of racisms, empire and slavery, the enduring colonial patterns of power and hierarchies come into view. We see how knowledge production in dentistry has neglected the interconnected histories of colonialism, racial capitalism and patriarchy that continue to shape oral health inequalities and work towards promoting white supremacist beauty ideals. Moreover, the interconnected character of inequalities - race, class and gender - begin to emerge. Second, by proceeding from the place of colonialism, the limits of dental knowledge and the violence embedded in knowledge practices emerge. This highlights the need for new ways of knowing. To decolonise is to confront and weaken the dental discipline's entanglement with the enduring colonial patterns of power and hierarchies that are complicit in maintaining inequalities. Diversity without decolonisation will simply subsume marginalised voices into the existing hierarchised knowledge paradigm and continue to reproduce a hierarchised, unequal world. I argue that if dental schools want to address racial and intersectional inequalities, they need new transformative ways of learning and knowing to equip students to work towards social justice in the outside world.
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Affiliation(s)
- R Lala
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, UK
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Allport J, Choudhury R, Bruce-Wootton P, Reed M, Tate D, Malviya A. Efficacy of mupirocin, neomycin and octenidine for nasal Staphylococcus aureus decolonisation: a retrospective cohort study. Antimicrob Resist Infect Control 2022; 11:5. [PMID: 35012641 PMCID: PMC8744346 DOI: 10.1186/s13756-021-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/14/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) causes significant morbidity. Methicillin sensitive Staphylococcus aureus (MSSA) is the most frequent organism, and the majority are endogenous. Decolonisation reduces PJIs but there is a paucity of evidence comparing treatments. Aims; compare 3 nasal decolonisation treatments at (1) achieving MSSA decolonisation, (2) preventing PJI. METHODS Our hospital prospectively collected data on our MSSA decolonisation programme since 2013, including; all MSSA carriers, treatment received, MSSA status at time of surgery and all PJIs. Prior to 2017 MSSA carriers received nasal mupirocin or neomycin, from August 2017 until August 2019 nasal octenidine was used. RESULTS During the study period 15,958 primary hip and knee replacements were performed. 3200 (20.1%) were MSSA positive at preoperative screening and received decolonisation treatment, 698 mupirocin, 1210 neomycin and 1221 octenidine. Mupirocin (89.1%) and neomycin (90.9%) were more effective at decolonisation than octenidine (50.0%, P < 0.0001). There was no difference in PJI rates (P = 0.452). CONCLUSIONS Mupirocin and neomycin are more effective than octenidine at MSSA decolonisation. There was poor correlation between the MSSA status after treatment (on day of surgery) and PJI rates. Further research is needed to compare alternative MSSA decolonisation treatments.
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Affiliation(s)
- J Allport
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK.
| | - R Choudhury
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - P Bruce-Wootton
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - M Reed
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - D Tate
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - A Malviya
- Northumbria Healthcare NHS Trust, Department of Trauma and Orthopaedics, Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
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Döbele S, Mazzaferri F, Dichter T, de Boer G, Friedrich A, Tacconelli E. Modelling and Simulation of the Effect of Targeted Decolonisation on Incidence of Extended-Spectrum Beta-Lactamase-Producing Enterobacterales Bloodstream Infections in Haematological Patients. Infect Dis Ther 2021. [PMID: 34665434 DOI: 10.1007/s40121-021-00550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Haematological patients are at higher risk of bloodstream infections (BSI) after chemotherapy. The aim of this study was to develop a simulation model assessing the impact of selective digestive decontamination (SDD) of haematological patients colonised with extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) on the incidence of ESBL-E BSI after chemotherapy. Methods A patient population was created by a stochastic simulation model mimicking the patients’ states of colonisation with ESBL-E during hospitalisation. A systematic literature search was performed to inform the model. All ESBL-E carriers were randomised (1:1) to either the intervention (targeted SDD) or the control group (placebo). ESBL-E BSI incidence was the outcome of the model. Sensitivity analyses were performed by prevalence of ESBL-E carriage at hospital admission (low: < 10%, medium: 10–25%, high: > 25%), duration of neutropenia after receiving chemotherapy, administration of antibiotic prophylaxis with quinolones, and time interval between SDD and chemotherapy. Results The model estimated that the administration of targeted SDD before chemotherapy reduces the incidence of ESBL-E BSI in the hospitalised haematological population up to 27%. The greatest benefit was estimated in high-prevalence settings, regardless of the duration of neutropenia, the time interval before chemotherapy, and the administration of antibiotic prophylaxis with quinolones (p < 0.05). In medium-prevalence settings, SDD was effective in patients receiving quinolone prophylaxis, with either 1-day time interval before chemotherapy and a neutropenia duration > 6 days (p < 0.05) or 7-day time interval before chemotherapy and a neutropenia duration > 9 days (p < 0.05). No benefit was observed in low-prevalence settings. Conclusions Our model suggests that targeted SDD could decrease the rate of ESBL-E BSI in haematological carriers before chemotherapy in the setting of high ESBL-E prevalence at hospital admission. These estimates require confirmation by well-designed multicentre RCTs, including the assessment of the impact on resistance/disruption patterns of gut microbiome. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00550-3.
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Herrick C, Okpako O, Millington JDA. Unequal ecosystems of global health authorial expertise: Decolonising noncommunicable disease. Health Place 2021; 71:102670. [PMID: 34543840 DOI: 10.1016/j.healthplace.2021.102670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/24/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
The decolonisation agenda is gathering momentum in global health. Within this movement, one domain of analysis has been the ways in which the geographies of scholarly knowledge production (re)produce the inequities of coloniality. Drawing on the example of noncommunicable diseases (NCDs), here we deviate from this and instead examine the authorship of the key global documents that were used to ignite and mobilise the NCD advocacy agenda from 2000 to 2020. In doing so, we reflect on the changing ecosystems of authorial expertise. It shows that while the geographic distribution of expertise has broadened over time, the NCD domain remains a fairly tight and circumscribed network. Importantly this research also shows the complexities of ascribing location to expertise, a finding that speaks back to the decolonisation debate.
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Affiliation(s)
- Clare Herrick
- Department of Geography King's College London, Bush House NE Wing 6.07, London, WC2R 2LS, UK.
| | - Oritsematosan Okpako
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - James D A Millington
- Department of Geography King's College London, Bush House NE Wing 6.07, London, WC2R 2LS, UK
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Finn GM, Quinn R, Sanders K, Ballard W, Balogun-Katung A, Dueñas AN. Pandemics, Protests, and Pronouns: The Changing Landscape of Biomedical Visualisation and Education. Adv Exp Med Biol 2021; 1334:39-53. [PMID: 34476744 DOI: 10.1007/978-3-030-76951-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Events in early 2020 changed the landscape of education for the foreseeable future, perhaps permanently. Three events had a significant impact; (1) the Coronavirus disease 2019 (COVID-19) pandemic, (2) the death of George Floyd, which resulted in the most recent Black Lives Matter (BLM) protests, and (3) the Twitter storm, the resultant societal fallout and freedom of speech campaigns, following comments made by author JK Rowling which many deemed transphobic. These events had a differential impact on biomedical sciences, when compared to other sectors. COVID-19 resulted in a global lockdown, with higher education institutions closing campuses and moving to online-only delivery. This rapid change required radical shifts in the use of technology, with mass delivery of teaching at short notice. The BLM protests further raised awareness of the inequalities within society, particularly those experienced by Black people and other oppressed groups. As a result, there have been calls for the decolonisation of the curriculum. The implications of these three key events have led institutions to rethink their policies, teaching delivery, assessment, curricula, and physical environments. This chapter considers (1) the implications of a swift change in the primary mode of curriculum delivery within Higher Education to online formats and (2) how recent adverse events have resulted in calls for much-needed changes in visual representations within biomedical sciences. Finally, we consider (3) the role of the hidden curriculum and the potential impact of visual representations in curricula on the delivery of healthcare and the fight against health inequalities, which are often as a result of implicit biases. The year 2020 has proven timely in presenting the opportunity for change, provided through the power of imagery.
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Affiliation(s)
- Gabrielle M Finn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Rebecca Quinn
- Hull York Medical School, University of Hull, Hull, UK
| | - Katherine Sanders
- Centre for Anatomical and Human Sciences, Hull York Medical School, University of Hull, Hull, UK
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Fouche I, Andrews G. "Working from home is one major disaster": An analysis of student feedback at a South African university during the Covid-19 lockdown. Educ Inf Technol (Dordr) 2021; 27:133-155. [PMID: 34248388 PMCID: PMC8261400 DOI: 10.1007/s10639-021-10652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
The Covid-19 global pandemic has resulted in many countries moving teaching and learning online. South Africa is a country with major inequalities in terms of access to electricity, internet and information technologies, which have created considerable problems for online learning at institutions of higher learning in the country. In this paper, we analyse student feedback from two large undergraduate English courses at a school of Education of a major South African university. We specifically focus on two qualitative questions which asked students about the challenges they faced and the skills they developed in online learning. Results are considered through the lens of critical digital pedagogies and decolonisation. Our findings indicate that a lack of access and resources, disruptive home environments and unfamiliarity with online learning methods were significant obstacles for students. In addition, many students indicated developing computer skills and learning how to use online resources during the courses. The study suggests that online teaching and learning in South Africa and similar contexts exacerbates inequalities, and must be accompanied by rigorous support structures for students who are vulnerable in these contexts.
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Affiliation(s)
- Ilse Fouche
- Division of Languages, Literacies and Literatures, University of the Witwatersrand, Johannesburg, South Africa
| | - Grant Andrews
- Division of Languages, Literacies and Literatures, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
Background Global Health has increasingly gained international visibility and prominence. First and foremost, the spread of cross-border infectious disease arouses a great deal of media and public interest, just as it drives research priorities of faculty and academic programmes. At the same time, Global Health has become a major area of philanthropic action. Despite the importance it has acquired over the last two decades, the complex collective term “Global Health” still lacks a uniform use today. Objectives The objective of this paper is to present the existing definitions of Global Health, and analyse their meaning and implications. The paper emphasises that the term “Global Health” goes beyond the territorial meaning of “global”, connects local and global, and refers to an explicitly political concept. Global Health regards health as a rights-based, universal good; it takes into account social inequalities, power asymmetries, the uneven distribution of resources and governance challenges. Thus, it represents the necessary continuance of Public Health in the face of diverse and ubiquitous global challenges. A growing number of international players, however, focus on public-private partnerships and privatisation and tend to promote biomedical reductionism through predominantly technological solutions. Moreover, the predominant Global Health concept reflects the inherited hegemony of the Global North. It takes insufficient account of the global burden of disease, which is mainly characterised by non-communicable conditions, and the underlying social determinants of health. Conclusions Beyond resilience and epidemiological preparedness for preventing cross-border disease threats, Global Health must focus on the social, economic and political determinants of health. Biomedical and technocratic reductionism might be justified in times of acute health crises but entails the risk of selective access to health care. Consistent health-in-all policies are required for ensuring Health for All and sustainably reducing health inequalities within and among countries. Global Health must first and foremost pursue the enforcement of the universal right to health and contribute to overcoming global hegemony.
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Affiliation(s)
- Jens Holst
- Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Leipziger Strasse 123, D-36037, Fulda, Germany.
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Yendewa GA, Griffiss JM, Jacobs MR, Fulton SA, O'Riordan MA, Gray WA, Proskin HM, Winkle P, Salata RA. A two-part phase 1 study to establish and compare the safety and local tolerability of two nasal formulations of XF-73 for decolonisation of Staphylococcus aureus: A previously investigated 0.5mg/g viscosified gel formulation versus a modified formulation. J Glob Antimicrob Resist 2019; 21:171-180. [PMID: 31600598 DOI: 10.1016/j.jgar.2019.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Successful decolonisation of nasal Staphylococcus aureus (SA) carriage by mupirocin is limited by increasing drug resistance. This randomised, open-label, phase 1 study compared the safety and local tolerability of two nasal formulations of XF-73, a novel porphyrinic antibacterial with rapid intrinsic activity against SA. METHODS The study was performed in 60 healthy adults. In Part 1, eight non-SA carriers were randomised to groups of four subjects each and were treated with XF-73 concentrations of 0.5mg/g 2% gel or 2.0mg/g 2% gel. In Part 2, 52 persistent SA carriers were randomised to groups of 13 subjects each and were treated with XF-73 concentrations of 0.5mg/g 2% gel, 2.0mg/g 2% gel, 0.5mg/g 4% gel or 4% viscosified placebo gel. Plasma pharmacokinetic and pharmacodynamic studies were performed. Antistaphylococcal activity was assessed as the presence/absence of SA and by quantification of colonisation using a semiquantitative scale (SA score). RESULTS 56 subjects (8/8 from Part 1 and 48/52 from Part 2) completed the study, with 47/60 comprising the pharmacokinetic population and 48/60 the pharmacodynamic population. There was no measurable systemic absorption of XF-73. XF-73 treatment was associated with rapid reduction in SA score in all subjects. The most common treatment-emergent adverse events (TEAEs) were rhinorrhoea and nasal dryness (15.5% each in Parts 1 and 2). TEAEs were mild and resolved spontaneously. CONCLUSION XF-73 was well tolerated with minimal side effects at doses of 0.5mg/g 2% gel and 2.0mg/g 2% gel. These findings support further development of XF-73.
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Affiliation(s)
- George A Yendewa
- Department of Medicine and Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | | | - Michael R Jacobs
- Department of Pathology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Scott A Fulton
- Department of Medicine and Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Ann O'Riordan
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Wesley A Gray
- Department of Pediatrics, University of Toledo, Toledo, OH, USA
| | - Howard M Proskin
- Howard M. Proskin and Associates, Incorporated, Rochester, NY, USA
| | | | - Robert A Salata
- Department of Medicine and Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Pascoe M, Mahura O, Rossouw K. Transcribing and Transforming: Towards Inclusive, Multilingual Child Speech Training for South African Speech-Language Therapy Students. Folia Phoniatr Logop 2019; 72:108-119. [PMID: 31189168 DOI: 10.1159/000499427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Phonetic transcription may encourage engagement with language diversity in multilingual settings. We describe how transcription can be used to help South African speech-language therapy (SLT) students engage with the many languages spoken in their country. Objectives were to describe (a) the local context, (b) transcription in the curriculum, and (c) participant observations from staff facilitating the Child Speech course. METHOD AND MATERIALS A case study approach was used to investigate teaching and learning transcription in a real-life context, the undergraduate second-year Child Speech course in an SLT programme. Document review of curriculum and university documents, national policies, and international best practice guidelines took place, together with participant observations from facilitators. RESULTS We describe 4 activities that show how transcription skills can be developed while introducing local languages into the curriculum. These activities give students the opportunity to develop transcription skills for a range of local languages, while at the same time encouraging them to learn the languages, construct communal resources, and promote a problem-solving attitude to their practice. CONCLUSION Calls to transform higher education in South Africa and "decolonise" curricula are key drivers underpinning this work. Transcription may be a useful tool in preparing students to practise in a multilingual context.
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Affiliation(s)
- Michelle Pascoe
- University of Cape Town Division of Communication Sciences and Disorders, Cape Town, South Africa,
| | - Olebeng Mahura
- University of Cape Town Division of Communication Sciences and Disorders, Cape Town, South Africa
| | - Katherine Rossouw
- University of Cape Town Division of Communication Sciences and Disorders, Cape Town, South Africa
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Saïdani N, Lagier JC, Cassir N, Million M, Baron S, Dubourg G, Eldin C, Kerbaj J, Valles C, Raoult D, Brouqui P. Faecal microbiota transplantation shortens the colonisation period and allows re-entry of patients carrying carbapenamase-producing bacteria into medical care facilities. Int J Antimicrob Agents 2018; 53:355-361. [PMID: 30472293 DOI: 10.1016/j.ijantimicag.2018.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/02/2018] [Accepted: 11/17/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Colonisation with carbapenemase-producing Enterobacteriaceae or Acinetobacter (CPE/A) is associated with complex medical care requiring implementation of specific isolation policies and limitation of patient discharge to other medical facilities. Faecal microbiota transplantation (FMT) has been proposed in order to reduce the duration of gut colonisation. OBJECTIVES This study investigated whether a dedicated protocol of FMT could reduce the negativation time of CPE/A intestinal carriage in patients whose medical care has been delayed due to such colonisation. METHOD A matched case-control retrospective study between patients who received FMT treatment and those who did not among CPE/A-colonised patients addressed for initial clustering at the current institute. The study adjusted two controls per case based on sex, age, bacterial species, and carbapenemase type. The primary outcome was delay in negativation of rectal-swab cultures. RESULTS At day 14 post FMT, 8/10 (80%) treated patients were cleared for intestinal CPE/A carriage. In the control group, 2/20 (10%) had spontaneous clearance at day 14 after CPE/A diagnosis. Faecal microbiota transplantation led patients to reduce the delay in decolonisation (median 3 days post FMT for treated patients vs. 50.5 days after the first documentation of digestive carriage for control patients) and discharge from hospital (median 19.5 days post FMT for treated patients vs. 41 for control patients). CONCLUSION Faecal microbiota transplantation is a safe and time-saving procedure to discharge CPE/A-colonised patients from the hospital. A standardised protocol, including 5 days of antibiotic treatment, bowel cleansing and systematic indwelling devices removal, should improve protocol effectiveness.
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Affiliation(s)
- Nadia Saïdani
- AP-HM, IHU-Méditerranée Infection, Marseille, France
| | - Jean-Christophe Lagier
- AP-HM, IHU-Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD, IHU-Méditerranée Infection, MEPHI, Marseille, France.
| | - Nadim Cassir
- AP-HM, IHU-Méditerranée Infection, Marseille, France
| | - Matthieu Million
- AP-HM, IHU-Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD, IHU-Méditerranée Infection, MEPHI, Marseille, France
| | - Sophie Baron
- AP-HM, IHU-Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD, SSA, IHU-Méditerranée Infection, VITROME, Marseille, France
| | - Grégory Dubourg
- AP-HM, IHU-Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD, IHU-Méditerranée Infection, MEPHI, Marseille, France
| | - Carole Eldin
- AP-HM, IHU-Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD, IHU-Méditerranée Infection, MEPHI, Marseille, France
| | - Jad Kerbaj
- AP-HM, IHU-Méditerranée Infection, Marseille, France
| | - Camille Valles
- Aix Marseille Université, IRD, IHU-Méditerranée Infection, MEPHI, Marseille, France
| | - Didier Raoult
- AP-HM, IHU-Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD, IHU-Méditerranée Infection, MEPHI, Marseille, France
| | - Philippe Brouqui
- AP-HM, IHU-Méditerranée Infection, Marseille, France; Aix Marseille Université, IRD, IHU-Méditerranée Infection, MEPHI, Marseille, France
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21
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Wilk CM, Weber I, Seidl K, Rachmühl C, Holzmann-Bürgel A, Müller AMS, Kuster SP, Schanz U, Zinkernagel AS. Impact of oral gut decontamination on Staphylococcus aureus colonisation in patients undergoing allogeneic haematopoietic stem cell transplantation. Int J Antimicrob Agents 2017; 50:726-729. [PMID: 28797807 DOI: 10.1016/j.ijantimicag.2017.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/06/2017] [Accepted: 08/01/2017] [Indexed: 11/19/2022]
Abstract
Recipients of allogeneic haematopoietic stem cell transplantation (allo-HSCT) are severely immunocompromised and are at increased risk of infection. In this prospective, observational, single-centre study including 110 allo-HSCT recipients, the rate of Staphylococcus aureus colonisation was reduced from 11.8% to 0% (P <0.001) following peritransplant oral gut decontamination. No invasive S. aureus infections were observed.
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Affiliation(s)
- C Matthias Wilk
- Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Isabel Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kati Seidl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carole Rachmühl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anne Holzmann-Bürgel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antonia M S Müller
- Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Urs Schanz
- Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Came H, Griffith D. Tackling racism as a "wicked" public health problem: Enabling allies in anti-racism praxis. Soc Sci Med 2017; 199:181-188. [PMID: 28342562 DOI: 10.1016/j.socscimed.2017.03.028] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 10/20/2022]
Abstract
Racism is a "wicked" public health problem that fuels systemic health inequities between population groups in New Zealand, the United States and elsewhere. While literature has examined racism and its effects on health, the work describing how to intervene to address racism in public health is less developed. While the notion of raising awareness of racism through socio-political education is not new, given the way racism has morphed into new narratives in health institutional settings, it has become critical to support allies to make informing efforts to address racism as a fundamental cause of health inequities. In this paper, we make the case for anti-racism praxis as a tool to address inequities in public health, and focus on describing an anti-racism praxis framework to inform the training and support of allies. The limited work on anti-racism rarely articulates the unique challenges or needs of allies or targets of racism, but we seek to help fill that gap. Our anti-racism praxis for allies includes five core elements: reflexive relational praxis, structural power analysis, socio-political education, monitoring and evaluation and systems change approaches. We recognize that racism is a modifiable determinant of health and racial inequities can be eliminated with the necessary political will and a planned system change approach. Anti-racism praxis provides the tools to examine the interconnection and interdependence of cultural and institutional factors as a foundation for examining where and how to intervene to address racism.
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Affiliation(s)
- Heather Came
- Faculty of Health and Environment Sciences, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand.
| | - Derek Griffith
- Centre for Medicine, Health and Society, Vanderbilt University, PMB #351665, 2301 Vanderbilt Pace, Nashville, TN 37235-1665, USA.
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Abstract
In this paper, I offer reflections as someone from outside the United States about the Swampscott conference. I refer to Fryer and Fox's (The Community Psychologist, 24, 2014, 1) critique of the "Swampscott discourse" and its role in fixing the birthplace of community psychology. While the critique is important, I note the growing references to international community psychology and the need to view the discipline as a product of social political realities in different contexts, as well as dynamics of dominance and marginality in knowledge production in psychology. The work in the Global South presents opportunities to contribute to developing a decolonizing community psychology through expanding the ecology of knowledge.
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Larsen J, David MZ, Vos MC, Coombs GW, Grundmann H, Harbarth S, Voss A, Skov RL. Preventing the introduction of meticillin-resistant Staphylococcus aureus into hospitals. J Glob Antimicrob Resist 2014; 2:260-268. [PMID: 27873685 DOI: 10.1016/j.jgar.2014.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/16/2014] [Accepted: 09/21/2014] [Indexed: 11/28/2022] Open
Abstract
The objective of this review was to provide an up-to-date account of the interventions used to prevent the introduction of meticillin-resistant Staphylococcus aureus (MRSA) from the expanding community and livestock reservoirs into hospitals in the USA, Denmark, The Netherlands and Western Australia. A review of existing literature and local guidelines for the management of MRSA in hospitals was performed. In Denmark, The Netherlands and Western Australia, where the prevalence of MRSA is relatively low, targeted admission screening and isolation of predefined high-risk populations have been used for several decades to successfully control MRSA in the hospital. Furthermore, in Denmark and The Netherlands, all identified MRSA carriers undergo routine decolonisation, whereas only carriers of particularly transmissible or virulent MRSA clones are subjected to decolonisation in Western Australia. In the USA, which continues to be a high-prevalence MRSA country, policies vary by state and even by hospital, and whilst guidelines from professional organisations provide a framework for infection control practices, these guidelines lack the authority of a legislative mandate. In conclusion, the changing epidemiology of MRSA, exemplified by the recent emergence of MRSA in the community and in food animals, makes it increasingly difficult to accurately identify specific high-risk groups to screen for MRSA carriage. Understanding the changing epidemiology of MRSA in a local as well as global context is fundamental to prevent the introduction of MRSA into hospitals.
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Affiliation(s)
- Jesper Larsen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen S, Denmark.
| | - Michael Z David
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Geoffrey W Coombs
- Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, Curtin University, Perth, WA, Australia; Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Hajo Grundmann
- Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan Harbarth
- Infection Control Program and Division of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Robert L Skov
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen S, Denmark
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Singh R, van Nood E, Nieuwdorp M, van Dam B, ten Berge IJM, Geerlings SE, Bemelman FJ. Donor feces infusion for eradication of Extended Spectrum beta-Lactamase producing Escherichia coli in a patient with end stage renal disease. Clin Microbiol Infect 2014; 20:O977-8. [PMID: 24845223 DOI: 10.1111/1469-0691.12683] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- R Singh
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands
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Chirisa IE, Mumba A, Dirwai SO. A review of the evolution and trajectory of the African union as an instrument of regional integration. Springerplus 2014; 3:101. [PMID: 24600549 PMCID: PMC3940719 DOI: 10.1186/2193-1801-3-101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 02/14/2014] [Indexed: 11/10/2022]
Abstract
This review paper seeks to analyse African integration in terms of its magnitude of solidarity, the state and typology of integration and functioning. It assesses the strengths, weaknesses, objectives, successes and failures of the African integration project as well as threats to its survival. The primary goal is to sift between issues with the view of better informing the future of the integration. The paper acknowledges how, in 2002, the OAU (formed in 1963) convened to reconstitute and become the African Union (AU) composed of eight Regional Economic Communities. The reformed union has spelt out gender equality, strategic planning, intra-trade, non-indifference to suffering in member states and sustainability, as additional objectives to those of the former OAU. This idea has been to foster integration to promote peace, security and cooperation hence solidarity. It can now be assessed succinctly that African integration has arisen in the need for amalgamation of efforts to solve African problems with African solutions.
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Affiliation(s)
- Innocent Ew Chirisa
- Department of Rural & Urban Planning, University of Zimbabwe, PO Box MP167, Mt Pleasant, Harare, (263-4) Zimbabwe
| | - Artwell Mumba
- Department of Rural & Urban Planning, University of Zimbabwe, PO Box MP167, Mt Pleasant, Harare, (263-4) Zimbabwe
| | - Simbarashe O Dirwai
- Department of Rural & Urban Planning, University of Zimbabwe, PO Box MP167, Mt Pleasant, Harare, (263-4) Zimbabwe
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Abstract
Recent evidence from publications describing the success of interventions to control hospital meticillin-resistant Staphylococcus aureus (MRSA), often in the endemic setting, is reviewed. Overall, there is cautious ground for optimism that MRSA can be controlled in a cost-effective manner by employing a bundle approach, the mainstay of which is widespread admission screening to inform patient-specific control measures.
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Affiliation(s)
- Ian M Gould
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
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