Manifesto for a new journal: Safeguarding critique in public health

Academic publishing is in a parlous state. In the context of the rise of populist politics, the use of misinformation and the generation of mistrust in scientific expertise, the need for informed and reasoned counter-critique has never been greater. Yet, opportunities for undertaking and publishing such critique are diminishing with the increased commercialization of academic publishing and research (Speed & Mannion 2017). There is thus a very real need to hold onto the historical gains made in establishing spaces for critical engagement.  In this editorial, we reflect on this context and set out a manifesto for maintaining a space for critique in this new journal

Time's up. Descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.This work was funded by the National Health and Medical Research Council ID (402793, 2006)

Views and experiences of opioid access amongst palliative care providers and public representatives in a low-resource setting: A qualitative interview study

AbstractOpioids (e.g. morphine) are affordable, effective interventions for cancer-related pain. However, equity of access to this key medication remains a global challenge, particularly in low- and middle-income countries. We aimed to explore views of palliative care providers and public-representatives about opioid analgesia access in two States in India. We conducted a qualitative study using semi-structured interviews. Transcribed audio-recordings were subjected to thematic analysis using a Framework Approach. Palliative care providers and public-representatives were purposively sampled from services reporting consistent opioid availability and prescribing (≥4kg per annum) from Karnataka and Kerala. Twenty participants (doctors (10), nurses (4), pharmacists (2), service managers (2) and public-representatives (2) were interviewed. Three themes were identified: 1) Attitudes and awareness: opioid treatments are perceived as end-of-life (last days/weeks) interventions; fears of addiction and misunderstanding of pain management goals limit access. 2) Expected and unexpected inequities: patients/carers from lower socioeconomic strata accept doctor recommendations if opioids are affordable, more educated patients/families have reservations about opioids, delay access and perceive expensive medicines as better. Non-palliative care specialist doctors have negative entrenched views and require specialist training. 3) Experiential learning–positive experiences can positively alter attitudes (e.g., participants in Kerala report improved attitudes, awareness and understanding influenced by exposure and community awareness, but experience can also reinforce perceptions as end-of-life care. Entrenched negative views are reinforced by poor experiences while positive experiences improve attitudes. To promote access, opioid prescribing must be needs-based rather than prognosis-based. Addressing the lack of training for non-palliative care workforce would help overcome a major barrier

A Greatly Under-Appreciated Fundamental Principle of Physical Organic Chemistry

If a species does not have a finite lifetime in the reaction medium, it cannot be a mechanistic intermediate. This principle was first enunciated by Jencks, as the concept of an enforced mechanism. For instance, neither primary nor secondary carbocations have long enough lifetimes to exist in an aqueous medium, so SN1 reactions involving these substrates are not possible, and an SN2 mechanism is enforced. Only tertiary carbocations and those stabilized by resonance (benzyl cations, acylium ions) are stable enough to be reaction intermediates. More importantly, it is now known that neither H3O+ nor HO− exist as such in dilute aqueous solution. Several recent high-level calculations on large proton clusters are unable to localize the positive charge; it is found to be simply “on the cluster” as a whole. The lifetime of any ionized water species is exceedingly short, a few molecular vibrations at most; the best experimental study, using modern IR instrumentation, has the most probable hydrated proton structure as H13O6+, but only an estimated quarter of the protons are present even in this form at any given instant. Thanks to the Grotthuss mechanism of chain transfer along hydrogen bonds, in reality a proton or a hydroxide ion is simply instantly available anywhere it is needed for reaction. Important mechanistic consequences result. Any charged oxygen species (e.g., a tetrahedral intermediate) is also not going to exist long enough to be a reaction intermediate, unless the charge is stabilized in some way, usually by resonance. General acid catalysis is the rule in reactions in concentrated aqueous acids. The Grotthuss mechanism also means that reactions involving neutral water are favored; the solvent is already highly structured, so the entropy involved in bringing several solvent molecules to the reaction center is unimportant. Examples are given

Creating a space for young women's voices: Using participatory 'video drama' in Uganda

This article draws upon research that explored the experiences of young women in relation to sexual health in Uganda with a view to enhancing gender-sensitive strategies. We have coined the phrase ‘participatory video drama’ to describe the exploratory methodology that the young women participants in our research used to present stories about their lives. The aim of this article is to suggest that ‘participatory video’ (PV) and ‘participatory video drama’ (PVD) are innovative methodological tools to utilise when working with participants who experience voicelessness in their everyday lives. We contribute to an emerging body of work around this methodology by suggesting that the process of PV provides a novel and engaging platform for participants to express their experiences. PVD further creates spaces for the performative exploration of embedded power relations and is therefore informative and has the potential to be transformatory and empowering

Knowledge, embodiment and neo-liberal drug policy

Contemporary social policy on drugs is centrally concerned with ensuring the orderly reproduction of the social life in the face of rapid social transformation. This paper examines some recent changes in the relationships of weljare and makes observations about the principles underlying contemporary European drug policy, with a particular concern for the governability of drug users. Expert knowledge is argued to play an important role in reconstructing the late-modern human agency through a focus on the intoxicated body. Contemporary drug policy is viewed as part of a set of discourses, norms, social practices and techniques that regulate the quality of the social life of a population, its health and security. These discourses and practices are related to a particular form of rationality specific to neo-liberalismfound in the UK, in Europe and in other Western societies. While subject to new forms of governance, it is argued that contemporary intoxicated subjectivity also falls under the influence of non-specialist, everyday knowledge, often contradicting the rationale of neo-liberal governance of drug use. </jats:p

British travelers and Egyptian ‘dancing girls:’ locating imperialism, gender, and sexuality in the politics of representation, 1834-1870

This project examines representations of two categories of Egyptian female entertainers, the ‘awâlim and ghawâzî. By situating Egypt’s ‘dancing girls’ in relation to the socio-cultural context of nineteenth-century Britain, it seeks to determine how gendered dynamics of power were culturally constructed and negotiated around these women. Such an approach breaks from previous historiographical contributions to the topic of Egyptian female entertainers by considering the wider implications of imperial power, gender, and sexuality within the politics of their representation. Chapter Two analyzes the cultural significance of the 1834 banishment of the ‘awâlim and ghawâzî from Cairo, and proposes alternative historical perspectives. Chapter Three explores parallels drawn by British travelogue authors between Egypt’s female entertainers and bourgeois archetypes of masculinity and prostitution. Finally, Chapter Four contemplates the impact of Egyptian ‘dancing girls’ upon British society and interprets the typecasting of the ‘awâlim and ghawâzî as indicative of underlying insecurities relating to imperialism and desire