Searching for Dignity: Barriers Encountered by Latina Immigrants in Search of Health Care

Objective This paper explores the structural barriers encountered among Latina immigrant women in a rural area of the mid-Atlantic eastern United States as they seek appropriate primary health care. Design For this qualitative study participants were recruited through a purposeful convenience sampling strategy and concomitant snowball recruiting. Semi-structured in-depth individual interviews were audiotaped, transcribed, translated when needed and reviewed for accuracy. NVIVO 11 provided a platform for coding and sorting into themes. Population The participants were 8 Latina immigrants in a rural area of the Eastern United States who have sought primary care in the country at least once. Participants were 18-65 year-old women of first or second-generation Latina families who speak fluent Spanish. Method This study used a Heideggerian interpretive phenomenological approach to data analysis. Findings The overarching theme that emerged was searching for dignity. Common barriers encountered included racism and assumptions about socio-economic class, lack of health systems literacy on the part of health care workers and the women themselves, communication barriers, differing cultural expectations. Emergent themes related to health care barriers included: need for trust, vulnerability, feeling like an outsider, and the desire to be treated the same as everyone else. Implications The findings suggest that structural barriers deny these Latina immigrants dignity, which in turn undermines their entire health care experience. Developing a shared agenda of mutual trust and understanding within community care systems would improve the health care experience while at the same time assisting women in learning how to navigate the system appropriately

Deterioration of muscle force and contractile characteristics are early pathological events in spinal and bulbar muscular atrophy mice

Spinal and bulbar muscular atrophy (SBMA), also known as Kennedy's Disease, is a late-onset, X-linked, progressive neuromuscular disease, which predominantly affects males. The pathological hallmarks of the disease are defined by selective loss of spinal and bulbar motor neurons, accompanied by weakness, atrophy and fasciculations of bulbar and limb muscles. SBMA is caused by a CAG repeat expansion in the gene that encodes the androgen receptor (AR) protein. Disease manifestation is androgen dependent and results principally from a toxic gain of AR function. There are currently no effective treatments for this debilitating disease. It is important to understand the course of the disease in order to target therapeutics to key pathological stages. This is especially relevant in disorders such as SBMA, where disease can be identified prior to symptom onset, through family history and genetic testing. To fully characterise the role of muscle in SBMA, we undertook a longitudinal physiological and histological characterisation of disease progression in the AR100 mouse model of SBMA. Our results show that the disease first manifests in skeletal muscle, prior to any motor neuron degeneration, which only occurs in late stage disease. These findings reveal alterations in muscle function, including reduced muscle force and changes in contractile characteristics, are early pathological events in SBMA mice and suggest that muscle-targeted therapeutics may be effective in SBMA

Microbiological quality evaluation of ready-to-eat mixed vegetable salad, food ingredients and some water samples from a restaurant in Accra: A case study

One serious threat to public health in both developed and developing countries is the microbial contamination of food. This problem poses a great challenge and consequently has economic implications. Causes of microbial contamination are diverse and these maybe natural, environmental, or technological. The microbiological quality of most readyto- eat foods is of great significance to human  health because they require minimal or no processing when consumed. The aim of this research was to investigate the microbiological quality of some ready-to-eat mixed vegetable salad foods, ingredients as well as the wash water samples of an urban restaurant located in Accra, Ghana. A total of thirty (30) samples categorized into mixed vegetable salads, foods and water obtained from an urban restaurant in the national capital of Ghana, Accra. They were analyzed at the microbiology laboratory and food microbiology  la  Loratories of School of Allied  Health Sciences (UHAS) and Council for Scientific and Industrial Research-Food Research Institute (CSIR-FRI), Ghana, respectively. Standard microbiological methods that are per International Organization for Standardization (ISO) Methods and Nordic Committee on Food Analysis Methods (NMKL) were used in determining the presence and levels of bacteria and fungi. Data obtained were transformed from standard to logarithmic forms and reported as mean+standard deviations. The aerobic plate countsamples ranged from 0- 4.73 log 10 CFU/g. E-coli counts also ranged between 0- 2.53 log 10 CFU, while Bacillus cereus counts were very low at 0-<10 log 10 CFU/g. Clostridium perfringens and Staphylococcus aureus counts were also very low ranging from 0- 1.0 log10 CFU/g. Enterobacteriaceae counts also ranged from 0- 1.90 log10 CFU/g. Molds and yeasts counts were generally low and ranged from  0- 2.48 log 10 CFU/g and 0- 1.0 log10 CFU/g, respectively. None of the samples tested contained Listeria monocytogenes and Salmonella spp. Fungal microbial loads were minimal given the quantities, and were deleterious to the health of consumers. The study revealed that the bacterial loads on mixed vegetable salads, ingredients and water samples used and served by an urban restaurant in Accra were within safe limits according to American Public Health Association (APHA) and International Commission for MicrobiologicalSpecifications for Foods (ICMSF) guidelines and, therefore, good for human consumption. Key words: Ready-to-eat, Salads, water, Vegetables, Restaurant, Ghana, Microbial contamination, Consumer safet

Structural barriers to health care access and IPV disclosure in first-generation Latina immigrants

Background: This study aimed to describe the unique structural barriers faced by Latina women in rural areas of Virginia as they attempt to access the health care system, and, once they have gained access, to identify barriers to intimate partner violence (IPV) disclosure. Methods: Semi-structured in-depth individual interviews with first-generation Latina immigrants were conducted after initial purposeful convenience sampling and concomitant snowball recruiting. A thematic content analysis using a phenomenological approach was employed to interpret participants\u27 experiences. Initial findings were validated through additional interviews. Results: The overarching theme expressed by these women was their search for dignity. Emergent sub-themes related to health care barriers and reluctance to disclose IPV included: no confianza, having a voice, being marginalized, and navigating a dysfunctional system. Discussion: Initial encounters with the health care system that led participants to feel disrespected interfered with care access and a sense of safety in answering intimate questions, especially concerning safety. The dysfunctional and disjointed health care system also creates unintended barriers to access and continuity of care. Conclusion and Recommendations: The experiences of barriers encountered by the women in our study suggests that reported discrepancies in IPV disclosure rates may be related to their level of perceived safety when being screened. In an effort to provide more accessible, safe and relevant care, an equity-informed approach such as trauma and violence informed care should be implemented within health care organizations to help provide more satisfying, safe and comprehensive care to immigrant populations

A cross sectional survey of international horse-racing authorities on injury data collection and reporting practices for professional jockeys

Jockey injuries are common in professional horse-racing and can result in life-threatening or career-ending outcomes. Robust injury data are essential to understand the circumstances of injury occurrence and ultimately identify prevention opportunities. This study aimed to identify jockey injury surveillance practices of international horse-racing authorities (HRAs) and the specific data items collected and reported by each HRA. A cross-sectional survey of representatives (e.g. Chief Medical Officer) from international HRAs was conducted. An online and paper questionnaire was designed comprised of 32 questions. Questions considered the barriers and facilitators to data collection within each HRA, and where available, what data were collected and reported by HRAs. Representatives from 15 international racing jurisdictions were included, of which 12 reported collection of race day injuries or falls, using varied definitions of medical attention and time loss. Six HRAs did not have a definition for a jockey injury, and eight HRAs had no parameters for describing injury severity. Race day exposure was collected by two HRAs. Results were commonly presented by HRAs as the number of injuries (n = 9/15) or proportion of injured jockeys (n = 6/15). The lack of a designated role for collection, collation and reporting of data was the main barrier for injury surveillance. Twelve HRAs agreed that mandatory collection would be a strong facilitator to improving practice. Enhancement and standardization of international jockey injury surveillance is required to move forward with evidence informed prevention. Concurrent investigation of how reporting practices can be best supported within existing HRA structures is recommended

Missed Opportunities for the Diagnosis of Pulmonary Tuberculosis in Ashanti and Western Regions of Ghana; Polymerase Chain Reaction, A Better Tool

The diagnosis of Pulmonary Tuberculosis (PTB) has mainly relied on sputum microscopy and culture. The use of molecular techniques such as the Polymerase Chain Reaction (PCR) and its overwhelming advantages compared with conventional diagnostic methodologies cannot be overemphasized. The main aim of this work was to compare the diagnostic sensitivities of microscopy, culture and PCR. Suspected PTB sputum samples were prospectively collected from six hospitals in the Ashanti and Western regions of Ghana. Microscopy was carried out on all samples at the field sites. Apart from culture and PCR, repeat sputum microscopy was carried out in the laboratories of the Kumasi Centre for Collaborative Research (KCCR). Out of the total 425 cases recruited for the study, 123 (29.0%) were smear positive on site in contrast to 275 (64.7%) positivity rate at KCCR. Regarding culture, 254 (59.9%) samples were culture positive whilst PCR technique using INS 1&2 and PR 8&9 primers were positive in 59.9 % and 56% of cases respectively. The proportion of missed positive cases of microscopy were 131 (51%) compared with culture and 1.1% missed cases when compared with PCR. The sensitivity and specificity of microscopy were 123/254 (48.4%) and 154/302 (50.99%). The study confirms the superiority of PCR in the diagnosis of PTB and indicates that a substantial proportion of PTB cases are missed when microscopy alone is used. In areas where the incidence of PTB is high and at referral hospitals, PCR can be done to augment the diagnosis of TB.Keywords: Pulmonary Tuberculosis, Sputum Microscopy, Culture, Polymerase Chain Reactio

Linking Community Participatory Research to Global Policymaking: Lessons Learned

The past two decades saw a proliferation of opportunities for the perspectives of people experiencing poverty and marginalisation to input into global policymaking spaces. So far these efforts have been contested, with attempts to embed participatory methodologies facilitating only limited consultation and falling into many pitfalls. While Participate was built on learning from previous attempts to influence global policy, we aimed to further understand participatory processes, and advance practical mechanisms for participation at every level of decision-making, from local to national and global. Participate emphasises the interactions between these levels and the importance of impacting multiple levels in order to create lasting, transformative change. This chapter describes what has been learnt about bringing the voices on the ground into global policymaking. We examine how and by whom the knowledge and evidence created were used, and the barriers and challenges to embedding this knowledge into global policy processes, through the following questions: • What have been the challenges to embedding participatory processes into global policy spaces? • What have these pathways of influence looked like, and what are some of the key lessons learned from these

Cdc5 influences phosphorylation of Net1 and disassembly of the RENT complex

BACKGROUND: In S. cerevisiae, the mitotic exit network (MEN) proteins, including the Polo-like protein kinase Cdc5 and the protein phosphatase Cdc14, are required for exit from mitosis. In pre-anaphase cells, Cdc14 is sequestered to the nucleolus by Net1 as a part of the RENT complex. When cells are primed to exit mitosis, the RENT complex is disassembled and Cdc14 is released from the nucleolus. RESULTS: Here, we show that Cdc5 is necessary to free nucleolar Cdc14 in late mitosis, that elevated Cdc5 activity provokes ectopic release of Cdc14 in pre-anaphase cells, and that the phosphorylation state of Net1 is regulated by Cdc5 during anaphase. Furthermore, recombinant Cdc5 and Xenopus Polo-like kinase can disassemble the RENT complex in vitro by phosphorylating Net1 and thereby reducing its affinity for Cdc14. Surprisingly, although RENT complexes containing Net1 mutants (Net1(7m) and Net1(19m') lacking sites phosphorylated by Cdc5 in vitro are refractory to disassembly by Polo-like kinases in vitro, net1(7m) and net1(19m') cells grow normally and exhibit only minor defects in releasing Cdc14 during anaphase. However, net1(19m') cells exhibit a synergistic growth defect when combined with mutations in CDC5 or DBF2 (another MEN gene). CONCLUSIONS: We propose that although Cdc5 potentially disassembles RENT by directly phosphorylating Net1, Cdc5 mediates exit from mitosis primarily by phosphorylating other targets. Our study suggests that Cdc5/Polo is unusually promiscuous and highlights the need to validate Cdc5/Polo in vitro phosphorylation sites by direct in vivo mapping experiments