46,596 research outputs found
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Reflections on the (Post-)Human Condition: Towards New Forms of Engagement with the World?
The main purpose of this paper is to examine the validity of the contention that, over the past decades, we have been witnessing the rise of the ‘posthuman condition’. To this end, the analysis draws on the work of the contemporary philosopher Rosi Braidotti. The paper is divided into four parts. The first part centres on the concept of posthumanism, suggesting that it reflects a systematic attempt to challenge humanist assumptions underlying the construction of ‘the human’. The second part focuses on the concept of post-anthropocentrism, demonstrating that it articulates a desire to reject the twin ideas of ‘species supremacism’ and ‘human exceptionalism’, which it seeks to replace with ‘species egalitarianism’ and ‘monistic vitalism’. The third part is concerned with the concept of critical posthumanities, positing that its advocacy is based on the cross-fertilization of posthumanism and post-anthropocentrism. The fourth part offers an assessment of the ‘posthuman condition’ thesis, evaluating the extent to which it sheds new light on the ways in which our engagements with the world are shaped by the confluence of zoe-, geo-, and techno-based dimensions. The paper concludes with a brief summary of the key insights gained from the preceding inquiry
Community engagement in Cutaneous Leishmaniasis research in Brazil, Ethiopia, and Sri Lanka: A decolonial approach for global health.
Cutaneous leishmaniasis (CL) is a parasitic skin disease endemic in at least 88 countries where it presents an urgent, albeit often "neglected" public health problem. In this paper, we discuss our model of decolonial community engagement in the ECLIPSE global health research program, which aims to improve physical and mental health outcomes for people with CL. The ECLIPSE program has four interlinked phases and underpinning each of these phases is sustained and robust community engagement and involvement that guides and informs all activities in ECLIPSE. Our decolonial approach implies that the model for community engagement will be different in Brazil, Ethiopia and Sri Lanka. Indeed, we adopt a critical anthropological approach to engaging with community members and it is precisely this approach we evaluate in this paper. The data and material we draw on were collected through qualitative research methods during community engagement activities. We established 13 Community Advisory Groups (CAGs): in Brazil ( = 4), Ethiopia ( = 6), and Sri Lanka ( = 3). We identified four overarching themes during a thematic analysis of the data set: (1) Establishing community advisory groups, (2) CAG membership and community representation, (3) Culturally appropriate and context-bespoke engagement, and (4) Relationships between researchers and community members. During our first period of ECLIPSE community engagement, we have debunked myths (for instance about communities being "disempowered"), critiqued our own practices (changing approaches in bringing together CAG members) and celebrated successes (notably fruitful online engagement during a challenging COVID-19 pandemic context). Our evaluation revealed a gap between the exemplary community engagement frameworks available in the literature and the messy, everyday reality of working in communities. In the ECLIPSE program, we have translated ideal(istic) principles espoused by such community engagement guidance into the practical realities of "doing engagement" in low-resourced communities. Our community engagement was underpinned by such ideal principles, but adapted to local sociocultural contexts, working within certain funding and regulatory constraints imposed on researchers. We conclude with a set of lessons learned and recommendations for the conduct of decolonial community engagement in global health research. [Abstract copyright: Copyright © 2022 Polidano, Parton, Agampodi, Agampodi, Haileselassie, Lalani, Mota, Price, Rodrigues, Tafere, Trad, Zerihun and Dikomitis.
Elite perceptions of the Victorian and Edwardian past in inter-war England
It is often argued by historians that members of the cultivated Elite after 1918 rejected the pre-war past. or at least subjected it to severe denigration. This thesis sets out to challenge such a view. Above all, it argues that inter-war critics of the Victorian and Edwardian past were unable to reject it even if that was what they felt inclined to do. This was because they were tied to those periods by the affective links of memory, family, and the continually unfolding consequences of the past in the present. Even the severest critics of the pre-war world, such as Lytton Strachey, were less frequently dismissive of history than ambivalent towards it. This ambivalence, it is argued, helped to keep the past alive and often to humanise it. The thesis also explores more positive estimation of Victorian and Edwardian history between the wars. It examines nostalgia for the past, as well as instances of continuity of practice and attitude. It explores the way in which inter-war society drew upon aspects of Victorian and Edwardian history both as illuminating parallels to contemporary affairs and to understand directly why the present was shaped as it was. Again, this testifies to the enduring power of the past after 1918. There are three parts to this thesis. Part One outlines the cultural context in which writers contemplated the Victorian and Edwardian past. Part Two explores some of the ways in which history was written about and used by inter-war society. Part Three examines the ways in which biographical depictions of eminent Victorians after 1918 encouraged emotional negotiation with the pas
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The Epidemiology and Genetic Architecture of Vitamin D Deficiency in African Children
Vitamin D deficiency is a common public health problem worldwide. However, little is known about the epidemiology of vitamin D deficiency in Africa. In this thesis, I aimed to determine: 1) the prevalence of and risk factors associated with vitamin D deficiency in studies conducted in Africa; 2) the prevalence and predictors of vitamin D deficiency in African children; 3) the association between vitamin D and iron deficiency in African children; and 4) genetic variants that influence vitamin D status in Africans.
In a systematic review and meta-analyses of previous vitamin D studies in Africa, the average prevalence of low vitamin D status was 18.5%, 34.2% and 59.5% using cut-offs of 25-hydroxyvitamin D (25(OH)D) levels of <30 nmol/L, <50 nmol/L and <75 nmol/L, respectively. Populations at risk of vitamin D deficiency included newborns, women, and people living in high latitudes or urban areas.
In an epidemiological study of young children living in Africa, the prevalence of low vitamin D status was 0.6%, 7.8% and 44.5% using cut-offs of 25(OH)D levels of GC2 variant of the group-specific component (GC) gene, which encodes vitamin D binding protein.
Vitamin D deficiency was also associated with 80% higher odds of iron deficiency in these children. Adjusted regression models revealed that vitamin D deficiency was associated with higher ferritin and hepcidin levels suggesting lower iron status, and reduced sTfR and transferrin levels and increased TSAT and serum iron levels suggesting improved iron status.
Genome-wide association study (GWAS) in Africans revealed genetic variants that influence vitamin D status in vitamin D metabolism genes: DHCR7/NADSYN1, CYP2R1 and GC. However, the majority of SNPs from previous European GWASs did not replicate in the current GWAS.
Findings from this thesis indicate that vitamin D deficiency is prevalent in many African populations and should be considered in public health strategies in Africa
A Scoping Review of interpreter-mediated assessments under the Mental Health Act (1983) and international equivalents
The purpose of this scoping review is to identify and evaluate available evidence concerning assessments under the Mental Health Act (1983) (MHA) (and international equivalents) which are carried out with the assistance of a spoken or signed language interpreter. ‘International equivalents’ refers to pieces of legislation in countries other than England and Wales that concern formal assessment for compulsory assessment and treatment, including hospital detention, with respect to a mental disorder. [Both the specific Act that applies to England and Wales and its international equivalents are henceforth
referred to as MHA].The guiding questions are:
•What are the enablers and barriers to good practice in interpreter mediated MHA assessments?
•To what extent and how might interpreter mediation support or impede the legal rights and best interests of those assessed under the MHA?
The aim is to determine whether the body of research available to date is sufficient to inform evidence-based guidelines for interpreters and for mental health professionals, in particular those who have the duty to make decisions under the MHA, known in England and Wales as Approved Mental Health Professional (AMHPs), to work in a joint and effective manner
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Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts.
BACKGROUND: Although 10 000 steps per day is widely promoted to have health benefits, there is little evidence to support this recommendation. We aimed to determine the association between number of steps per day and stepping rate with all-cause mortality. METHODS: In this meta-analysis, we identified studies investigating the effect of daily step count on all-cause mortality in adults (aged ≥18 years), via a previously published systematic review and expert knowledge of the field. We asked participating study investigators to process their participant-level data following a standardised protocol. The primary outcome was all-cause mortality collected from death certificates and country registries. We analysed the dose-response association of steps per day and stepping rate with all-cause mortality. We did Cox proportional hazards regression analyses using study-specific quartiles of steps per day and calculated hazard ratios (HRs) with inverse-variance weighted random effects models. FINDINGS: We identified 15 studies, of which seven were published and eight were unpublished, with study start dates between 1999 and 2018. The total sample included 47 471 adults, among whom there were 3013 deaths (10·1 per 1000 participant-years) over a median follow-up of 7·1 years ([IQR 4·3-9·9]; total sum of follow-up across studies was 297 837 person-years). Quartile median steps per day were 3553 for quartile 1, 5801 for quartile 2, 7842 for quartile 3, and 10 901 for quartile 4. Compared with the lowest quartile, the adjusted HR for all-cause mortality was 0·60 (95% CI 0·51-0·71) for quartile 2, 0·55 (0·49-0·62) for quartile 3, and 0·47 (0·39-0·57) for quartile 4. Restricted cubic splines showed progressively decreasing risk of mortality among adults aged 60 years and older with increasing number of steps per day until 6000-8000 steps per day and among adults younger than 60 years until 8000-10 000 steps per day. Adjusting for number of steps per day, comparing quartile 1 with quartile 4, the association between higher stepping rates and mortality was attenuated but remained significant for a peak of 30 min (HR 0·67 [95% CI 0·56-0·83]) and a peak of 60 min (0·67 [0·50-0·90]), but not significant for time (min per day) spent walking at 40 steps per min or faster (1·12 [0·96-1·32]) and 100 steps per min or faster (0·86 [0·58-1·28]). INTERPRETATION: Taking more steps per day was associated with a progressively lower risk of all-cause mortality, up to a level that varied by age. The findings from this meta-analysis can be used to inform step guidelines for public health promotion of physical activity. FUNDING: US Centers for Disease Control and Prevention
Modifying Group Interpersonal Psychotherapy for Peripartum Adolescents in Sub-Saharan African Context: Reviewing Differential Contextual and Implementation Considerations
Background: This study describes adaptation and modification of World Health Organization (WHO) recommended group interpersonal psychotherapy (IPT-G) for depressed peripartum adolescents. The adaptation process includes accommodating contextual factors and strategies to address intervention implementation barriers, such as engagement problems with adolescents, caregivers, and providers, and stigma and dearth of mental health specialists. The modifications include and adolescent relevant iterations to the therapy format and content.
Methods: A multi-stakeholder led two-stage intervention adaptation and modification process integrating mixed qualitative methods were used with pregnant and parenting adolescents, their partners, and health care workers. In-depth interviews focusing on personal, relationship, social, and cultural barriers experienced by adolescents were carried out modeled on the Consolidated Framework for Implementation Research. Focus group discussions with depressed adolescents on their experiences, feedback from caregivers, partners, health workers inform focused modifications. An IPT expert committee of three practitioners, along with UNICEF adolescent officer, and mental health policy expert from Ministry of Health and representative community advisory body reviewed the adaptations and modifications made to the WHO IPT-G manual.
Discussion: Integration of mental health needs of peripartum adolescents as demonstrated in the stakeholder engagement process, adaptation of key terms into locally relevant language, determination of number of sessions, and user-centric design modifications to digitize a brief version of group interpersonal psychotherapy are presented
Implementing Health Impact Assessment as a Required Component of Government Policymaking: A Multi-Level Exploration of the Determinants of Healthy Public Policy
It is widely understood that the public policies of ‘non-health’ government sectors have greater impacts on population health than those of the traditional healthcare realm. Health Impact Assessment (HIA) is a decision support tool that identifies and promotes the health benefits of policies while also mitigating their unintended negative consequences. Despite numerous calls to do so, the Ontario government has yet to implement HIA as a required component of policy development. This dissertation therefore sought to identify the contexts and factors that may both enable and impede HIA use at the sub-national (i.e., provincial, territorial, or state) government level.
The three integrated articles of this dissertation provide insights into specific aspects of the policy process as they relate to HIA. Chapter one details a case study of purposive information-seeking among public servants within Ontario’s Ministry of Education (MOE). Situated within Ontario’s Ministry of Health (MOH), chapter two presents a case study of policy collaboration between health and ‘non-health’ ministries. Finally, chapter three details a framework analysis of the political factors supporting health impact tool use in two sub-national jurisdictions – namely, Québec and South Australia.
MOE respondents (N=9) identified four components of policymaking ‘due diligence’, including evidence retrieval, consultation and collaboration, referencing, and risk analysis. As prospective HIA users, they also confirmed that information is not routinely sought to mitigate the potential negative health impacts of education-based policies. MOH respondents (N=8) identified the bureaucratic hierarchy as the brokering mechanism for inter-ministerial policy development. As prospective HIA stewards, they also confirmed that the ministry does not proactively flag the potential negative health impacts of non-health sector policies. Finally, ‘lessons learned’ from case articles specific to Québec (n=12) and South Australia (n=17) identified the political factors supporting tool use at different stages of the policy cycle, including agenda setting (‘policy elites’ and ‘political culture’), implementation (‘jurisdiction’), and sustained implementation (‘institutional power’).
This work provides important insights into ‘real life’ policymaking. By highlighting existing facilitators of and barriers to HIA use, the findings offer a useful starting point from which proponents may tailor context-specific strategies to sustainably implement HIA at the sub-national government level
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