Migrants’ health beliefs and their impact on general practice encounters: an in-depth interview study of French- and Swahili-speaking Africans and general practitioners working with migrant patients

Background. The growing population of migrants (including sub-Saharan Africans) in the United Kingdom poses challenges to British general practice. First, migrants tend to seek health care at times of crisis rather than for preventive measures. This is despite being at increased risk of certain chronic conditions compared with the indigenous population. For sub-Saharan Africans this includes hypertension-related diseases and some cancers. Little has been published about Africans’ awareness of this risk or their knowledge of associated causative factors. Second, discordant health beliefs and healthcare expectations between migrants and doctors in the UK have been found to undermine trust during consultations with general practitioners and to lead to poor patient satisfaction. Little is known about the health behaviours of African migrants whose expectations are not met by primary care in the UK. A related area where health beliefs and practices differ between African migrants and their GPs is in the use of traditional medicines. A final challenge lies in considering the wider issues that GPs must address when consulting with migrant patients, including time pressures, organisational factors and the complex nature of problems presented by migrant patients. These issues are the focus of this study. Aims. To examine African migrants’ perceptions of chronic disease and their experience of seeking primary health care in the UK. To explore the impact upon GPs of caring for migrants. Objectives. To explore: 1) perceptions of chronic disease risk facing African migrants and their underlying explanatory models; 2) experiences of consultations about antibiotic prescriptions; 3) traditional African medicine use in the UK; and (4) to consider the effect of workload and work patterns on GP consultations with migrants. Design. In-depth interviews were conducted with 19 Africans from French- or Swahili- speaking countries, one African key informant and 13 GPs working with migrants. African participant recruitment was from community organisations and GPs were approached via an informal network of doctors. Interviews were transcribed and ten were translated by the principal investigator (three Swahili and seven French). Data analysis was undertaken following the approach of applied thematic analysis using the Nvivo software package. Data collection and analyses were underpinned by the following theoretical frameworks: Kleinman’s explanatory models of illness and of cultural health care systems and Lipsky’s street-level bureaucracy. Results. Narratives suggested low awareness of chronic disease risk amongst Africans. Infectious diseases were considered the dominant health threat for African migrants, mainly HIV but also tuberculosis and ‘flu’. Chronic diseases were sometimes described by Africans as contagious. Explanatory models of chronic disease included bodily/dietary imbalance, stress/exertion, heredity/predisposition and food contamination. Cancer was feared but not considered a major threat. Cancer was considered more common in Europe than in Africa and was attributed by Africans to chemical contamination from fertilizers, food preservatives and industrial pollution. Evidence cited for these chemicals was rapid livestock/vegetable production, large size of farmed products (e.g. fish), softness of meat and flavourless food. Chemicals were reported to circulate silently inside the body and cancer to develop in the part where they deposit, sometimes years later. Africans’ belief in infective explanations of disease extended to minor illnesses and was manifested in an expectation of antibiotics from GPs for problems such as a sore throat. This arose from participants’ experience in Africa, witnessing life-threatening infectious diseases and experience of unregulated access to antibiotics. Africans described various alternative measures to fulfil their unmet expectations, including approaching other National Health Service doctors, importing medication, and using private healthcare services in London, francophone Europe and east Africa. A further option was the use of traditional African medicine, reported by one quarter of African participants. Traditional African herbal medicine use was based upon a perception of its purity and natural origin in African soil and a deep belief in its efficacy. Consulting traditional African healers in the UK was reported to be undertaken in secret. Some GPs and Africans described consultations in terms of pressure, processing and conflict. Migrants were reported to present with complex health problems that were frequently compounded by language barriers. GPs described a need to remain in control of consultations and this included some use of personal discretion to render their tasks easier to complete. The most common example was accepting patients’ family and friends as informal interpreters – a choice that ran contrary to formal policy of only using professional interpreters. Burnout was reported to be one consequence of excessive workload for patient-centred GPs working with vulnerable groups like asylum seekers. Conclusions. There is a need to improve health literacy amongst African migrants in order to promote preventive behaviours for chronic disease and alternatives to antibiotics for minor illnesses. As part of this, further research is required into the use and properties of traditional African medicine. Interventions should be built upon participants’ existing knowledge of disease causation, their self-reliance in the pursuit of a healthy lifestyle and desire to retain cultural practices. One challenge to improving migrant health lies in the service dilemmas facing GPs, including excessive workload, the complex nature of migrants’ presenting problems and professional dilemmas. GPs who act as advocates for vulnerable migrant patients may be at increased risk of burnout and greater consideration should be given to providing them with appropriate support

Computational strategies to identify, prioritize and design potential antimalarial agents from natural products

Philosophiae Doctor - PhDIntroduction: There is an exigent need to develop novel antimalarial drugs in view of the mounting disease burden and emergent resistance to the presently used drugs against the malarial parasites. A large amount of natural products, especially those used in ethnomedicine for malaria, have shown varying in-vitro antiplasmodial activities. Facilitating antimalarial drug development from this wealth of natural products is an imperative and laudable mission to pursue. However, the limited resources, high cost, low prospect and the high cost of failure during preclinical and clinical studies might militate against pursue of this mission. Chemoinformatics techniques can simulate and predict essential molecular properties required to characterize compounds thus eliminating the cost of equipment and reagents to conduct essential preclinical studies, especially on compounds that may fail during drug development. Therefore, applying chemoinformatics techniques on natural products with in-vitro antiplasmodial activities may facilitate identification and prioritization of these natural products with potential for novel mechanism of action, desirable pharmacokinetics and high likelihood for development into antimalarial drugs. In addition, unique structural features mined from these natural products may be templates to design new potential antimalarial compounds. Method: Four chemoinformatics techniques were applied on a collection of selected natural products with in-vitro antiplasmodial activity (NAA) and currently registered antimalarial drugs (CRAD): molecular property profiling, molecular scaffold analysis, machine learning and design of a virtual compound library. Molecular property profiling included computation of key molecular descriptors, physicochemical properties, molecular similarity analysis, estimation of drug-likeness, in-silico pharmacokinetic profiling and exploration of structure-activity landscape. Analysis of variance was used to assess statistical significant differences in these parameters between NAA and CRAD. Next, molecular scaffold exploration and diversity analyses were performed on three datasets (NAA, CRAD and malarial data from Medicines for Malarial Ventures (MMV)) using scaffold counts and cumulative scaffold frequency plots. Scaffolds from the NAA were compared to those from CRAD and MMV. A Scaffold Tree was also generated for all the datasets. Thirdly, machine learning approaches were used to build four regression and four classifier models from bioactivity data of NAA using molecular descriptors and molecular fingerprints. Models were built and refined by leave-one-out cross-validation and evaluated with an independent test dataset. Applicability domain (AD), which defines the limit of reliable predictability by the models, was estimated from the training dataset and validated with the test dataset. Possible chemical features associated with reported antimalarial activities of the compounds were also extracted. Lastly, virtual compound libraries were generated with the unique molecular scaffolds identified from the NAA. The virtual compounds generated were characterized by evaluating selected molecular descriptors, toxicity profile, structural diversity from CRAD and prediction of antiplasmodial activity. Results: From the molecular property profiling, a total of 1040 natural products were selected and a total of 13 molecular descriptors were analyzed. Significant differences were observed between the natural products with in-vitro antiplasmodial activities (NAA) and currently registered antimalarial drugs (CRAD) for at least 11 of the molecular descriptors. Molecular similarity and chemical space analysis identified NAA that were structurally diverse from CRAD. Over 50% of NAA with desirable drug-like properties were identified. However, nearly 70% of NAA were identified as potentially "promiscuous" compounds. Structure-activity landscape analysis highlighted compound pairs that formed "activity cliffs". In all, prioritization strategies for the natural products with in-vitro antiplasmodial activities were proposed. The scaffold exploration and analysis results revealed that CRAD exhibited greater scaffold diversity, followed by NAA and MMV respectively. Unique scaffolds that were not contained in any other compounds in the CRAD datasets were identified in NAA. The Scaffold Tree showed the preponderance of ring systems in NAA and identified virtual scaffolds, which maybe potential bioactive compounds or elucidate the NAA possible synthetic routes. From the machine learning study, the regression and classifier models that were most suitable for NAA were identified as model tree M5P (correlation coefficient = 0.84) and Sequential Minimization Optimization (accuracy = 73.46%) respectively. The test dataset fitted into the applicability domain (AD) defined by the training dataset. The “amine” group was observed to be essential for antimalarial activity in both NAA and MMV dataset but hydroxyl and carbonyl groups may also be relevant in the NAA dataset. The results of the characterization of the virtual compound library showed significant difference (p value 90%) of the virtual compound library. The virtual compound libraries showed sufficient diversity in structures and majority were structurally diverse from currently registered antimalarial drugs. Finally, up to 70% of the virtual compounds were predicted as active antiplasmodial agents. Conclusions:Molecular property profiling of natural products with in-vitro antiplasmodial activities (NAA) and currently registered antimalarial drugs (CRAD) produced a wealth of information that may guide decisions and facilitate antimalarial drug development from natural products and led to a prioritized list of natural products with in-vitro antiplasmodial activities. Molecular scaffold analysis identified unique scaffolds and virtual scaffolds from NAA that possess desirable drug-like properties, which make them ideal starting points for molecular antimalarial drug design. The machine learning study built, evaluated and identified amply accurate regression and classifier accurate models that were used for virtual screening of natural compound libraries to mine possible antimalarial compounds without the expense of bioactivity assays. Finally, a good amount of the virtual compounds generated were structurally diverse from currently registered antimalarial drugs and potentially active antiplasmodial agents. Filtering and optimization may lead to a collection of virtual compounds with unique chemotypes that may be synthesized and added to screening deck against Plasmodium

Decision Support Systems

Decision support systems (DSS) have evolved over the past four decades from theoretical concepts into real world computerized applications. DSS architecture contains three key components: knowledge base, computerized model, and user interface. DSS simulate cognitive decision-making functions of humans based on artificial intelligence methodologies (including expert systems, data mining, machine learning, connectionism, logistical reasoning, etc.) in order to perform decision support functions. The applications of DSS cover many domains, ranging from aviation monitoring, transportation safety, clinical diagnosis, weather forecast, business management to internet search strategy. By combining knowledge bases with inference rules, DSS are able to provide suggestions to end users to improve decisions and outcomes. This book is written as a textbook so that it can be used in formal courses examining decision support systems. It may be used by both undergraduate and graduate students from diverse computer-related fields. It will also be of value to established professionals as a text for self-study or for reference

Continuing professional development - challenge for professional organization

Professions, as one of key sectors of social systems, bear a leading role in the existing social work organization. Free professions take up a special place and significance, all the way from Roman artes liberales to our times. Pharmaceutical profession, as one of the oldest, led by ethical principles, is regulated by postulates accepted by the profession members, and in modern times established through legislations. Typical determinants of the regulated professions, which also refer to pharmacists, as chamber members, are as follows: following ethical principles, specific skills and knowledge, professional development, autonomy at work, continuing improvement, competencies development, professional associations, licensing

Ecological, genetic and cultural status of Solanum aviculare, poroporo (Solanaceae)

Solanum aviculare, endemic to Australasia, is an opportunist pioneer secondary successional plant occupying disturbed and open lowland habitats, and was an important medicinal and cultural species to Māori known as poroporo. It is currently in 'decline', the ecological decline appearing to correspond to a decline in knowledge and cultural use of the species. To gain understanding of the reasons for the decline, enhance ecological knowledge, assist conservation and cultural restoration of Solanum aviculare this research documented the successional role and cycle of regeneration dynamics and tactics, established morphological characteristics, investigated the genetic diversity and recorded cultural and conservation information. The successional status and role was identified. Growth data identified cohort development and inter-site differences, metadata found height and crown spread growth to be significantly correlated and likely part of an early reproduction and dispersal strategy. Germination of soil cores from differing depths confirmed a viable seed bank exists sufficient for species maintenance. Viable seed spread via animal gut passage was determined by germination and chemical tests, results showed rats passed higher rates of viable seed than birds. Seed germination trials with stratified and fresh seed confirmed temporal and depth behaviour, flowering observation documented temporal differences with the closely allied species Solanum laciniatum, indicating a relationship to stasis induction. Leaf morphology studies documented differences between the two allied species and proposed further nomenclature. Genetic diversity was investigated through the use of PCR/ISSR techniques. Chloroplast DNA was extracted by CTAB and DNA kit protocols. CTAB extraction was unable to effectively remove RNA, although use of DNA samples with high quantities of RNA confirmed that RNA was not an inhibiting factor in PCR production. The production of consistent reliable ISSR bands proved difficult, with no technical explanation found. ISSR findings indicate that Solanum aviculare is highly monomorphic, consisting of predominant invariant monomorphic loci. Twenty primers were tested with no polymorphic loci identified and no intra species variation documented. Indications were also that Solanum aviculare and Solanum laciniatum are inter species invariant on monomorphic loci. Monomorphic loci may possibly be the evolutionary markers of generic differentiation within Solanum. Surveys identified Solanum aviculare as uncommon and rare, existing mainly as single plants or small groups in the majority of areas surveyed. The Threatened and Uncommon Plant listing of Solanum aviculare as an 'at risk declining' species is confirmed and a further Recommendation category proposed. Ecological decline and corresponding decline in cultural use and knowledge of Solanum aviculare was identified through specialist interviews; appearing to be related to removal from Māori of control over their land. The name poroporo being now associated mainly with non indigenous Solanum species. Māori cultural concepts in practice were highlighted as fundamentally important to reversing the decline, with an example of a successful traditional practice based (tikanga) integrative collaborative restoration program being documented. This research forwards that optimal collaborative solutions, programs integrating scientific and tikanga knowledge and practices, provide the best opportunity of reversing the declining trend and for increasing and maintaining knowledge associated with the traditional role of poroporo

2013 Oklahoma Research Day Full Program

This document contains all abstracts from the 2013 Oklahoma Research Day held at the University of Central Oklahoma