How do patients from South Asian backgrounds experience life on haemodialysis in the UK? : A multicentre qualitative study

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: End-stage kidney disease disproportionately affects people of South Asian origin. This study aimed to uncover the lived experiences of this group of patients on centre-based haemodialysis (HD), the most prevalent dialysis modality. DESIGN: The study utilised a qualitative focus group methodology. Seven focus groups were conducted across four NHS Trusts in the UK including three in Gujarati and two each in Punjabi and Urdu. This provided an inclusive opportunity for South Asian patients to contribute in their language of origin. A total of 24 patients participated. Focus groups were facilitated by bilingual project workers and data were forward translated and analysed using thematic analysis. RESULTS: Four themes were identified. This included (1) 'treatment imposition', which comprised of the restrictive nature of HD, the effects of treatment and the feeling of being trapped in an endless process. (2) The 'patient-clinician relationship' centred around the impact of a perceived lack of staff time, and inadequacies in the quality of interactions. (3) 'Coping strategies' highlighted the role of cognitive reappraisal, living in the moment and family support networks in facilitating adjustment. (4) 'Pursuit of transplantation' included equating this form of treatment with restoring normality, alongside cultural factors limiting hopefulness for receiving an organ. CONCLUSIONS: In general, the experiences of South Asian patients receiving HD were not unique to this ethnic group. We did find distinct issues in relation to interactions with healthcare professionals, views on access to transplantation and the importance of family support networks. The study provides useful insights which may help enhance culturally tailored renal care.Peer reviewe

ANÁLISIS DE LAS PRÁCTICAS DE PROCESAMIENTO Y COCCIÓN DE RECURSOS ANIMALES EN SOCIEDADES CAZADORAS, RECOLECTORAS Y PESCADORAS DEL LITORAL DEL RÍO DE LA PLATA DURANTE EL HOLOCENO TARDÍO. UNA APROXIMACIÓN EXPERIMENTAL

A partir de la información obtenida en diversos análisis arqueozoológicos, arqueobotánicos, cerámicos, líticos, experimentales y etnohistóricos se caracterizaron a las poblaciones que habitaron los actuales partidos de Magdalena y Punta Indio (provincia de Buenos Aires) hace 2000 años aproximadamente, como sociedades cazadoras, recolectoras, pescadoras y ceramistas. Se identificaron distintos sitios arqueológicos: Las Marías (Magdalena) y San Clemente I, II, III, IV y VI de la localidad arqueológica Barrio San Clemente (Punta Indio). Se consignaron distintos momentos de ocupación en el área, una temprana desde los 1800 a los 1500 años AP (fechados radiométricos de LM 1590 ± 40 AP y 1820 ± 50 AP y de SC III 1550 ± 90 AP), otro momento entre los 800 y 900 años AP (fechados radiométricos de los sitios SC II 817 ± 48 AP y SC VI 935 ± 55 AP) y una ocupación más reciente alrededor de los 300 años AP, definida como posthispánica (representada por el sitio SC IV 340 ± 45 AP) El registro arqueofaunístico se compone de numerosos restos, en donde registramos una importante variedad de taxones, como peces, anuros, reptiles, aves y mamíferos de distintos tamaños. Una de las particularidades del registro arqueofaunístico es la baja proporción de modificaciones antrópicas en relación a la cantidad de restos recuperados y analizados en todos los sitios arqueológicos. En el presente plan de trabajo, se propone indagar sobre las prácticas de procesamiento y cocción de especies animales identificadas en el registro arqueofaunístico mediante la implementación de una serie de estudios experimentales. Se considera que la experimentación puede brindar un acercamiento empírico a lo observado en el registro arqueofaunístico mediante la reconstrucción, dirigida y controlada, de las prácticas de procesamiento y cocción de los recursos animales. La experimentación aplicada a la arqueología es una herramienta sumamente valiosa para observar el registro arqueológico, generar nueva información, plantearnos nuevos interrogantes, ampliar nuestra capacidad interpretativa, además de ser un modelo de contrastación de las hipótesis enunciadas a partir de los conocimientos adquiridos previamente. Se realizarán réplicas de instrumentos líticos para llevar adelante el procesamiento de ejemplares de corvina negra, cuis pampeano y venado. Se implementarán distintas actividades de procesamiento (cuereo, evisceración, desarticulación, etc) y prácticas de cocción según el tamaño y aprovechamiento del recurso animal considerado (asado, hervido y guisado en réplicas de vasijas cerámicas que se encuentran en el Laboratorio). Luego se analizarán las modificaciones en los huesos de los individuos (marcas de corte, de raspado, de percusión, negativos de impacto y/o lascados, fracturas, termoalteraciones, pérdida de partes esqueletarias, roturas, entre otras) siguiendo la metodología de estudio de los conjuntos arqueofaunísticos (observación y registro de los distintos atributos de las modificaciones: localización, cantidad, profundidad, longitud y orientación de las marcas, coloración de las termoalteraciones, entre otras), como así también en las trazas de uso en los artefactos líticos. Finalmente, se realizará la comparación de los conjuntos óseos experimentales con el registro arqueofaunísticos. De esta manera, no sólo se reinterpretarán o ajustarán las prácticas de procesamiento y  cocción que realizaron las sociedades del pasado en el litoral del Río de la Plata, sino que también se generará un corpus de consulta para próximas investigaciones

Analysis of the Practices of Processing and Cooking of Animal Resources in Hunting, Gathering and Fishing Societies of the Río de la Plata Coast During the Late Holocene. An Experimental Approach

En el trabajo de tesis doctoral (Day Pilaría 2018) se analizaron los conjuntos arqueozoológicos recuperados en seis sitios arqueológicos que cronológicamente pertenecen al Holoceno tardío, con antigüedades entre los 1800 años AP y los 340 años AP, y se están ubicados en el litoral del Río de la Plata (partidos de Magdalena y Punta Indio, Bs. As). Se identificaron una importante variedad de grupos taxonómicos y especies animales como peces, anuros, ofidios, aves, mamíferos autóctonos de distintos tamaños, entre los que se encuentran cérvidos, carnívoros marinos y terrestres, ungulados, dasipódidos y roedores caviomorfos, además de algunos mamíferos introducidos (Day Pilaría 2018). Una particularidad de los conjuntos analizados es la baja proporción de modificaciones deorigen antrópico, como fracturas frescas, marcas de corte, de percusión, negativos de impacto y lascados, termoalteraciones, que permitan interpretar las actividades de aprovechamiento de los recursos animales y discutir sobre las prácticas de consumo que desarrollaron las sociedades en el pasado.Universidad Nacional de La Plat

Análisis de las prácticas de procesamiento y cocción de recursos animales en sociedades cazadoras, recolectoras y pescadoras del litoral del río de La Plata durante el Holoceno tardío : Una aproximación experimental

En el presente plan de trabajo, se propone indagar sobre las prácticas de procesamiento y cocción de especies animales identificadas en el registro arqueofaunístico mediante la implementación de una serie de estudios experimentales. Se considera que la experimentación puede brindar un acercamiento empírico a lo observado en el registro arqueofaunístico mediante la reconstrucción, dirigida y controlada, de las prácticas de procesamiento y cocción de los recursos animales. La experimentación aplicada a la arqueología es una herramienta sumamente valiosa para observar el registro arqueológico, generar nueva información, plantearnos nuevos interrogantes, ampliar nuestra capacidad interpretativa, además de ser un modelo de contrastación de las hipótesis enunciadas a partir de los conocimientos adquiridos previamente.Universidad Nacional de La Plat

‘I feel weak, useless and dependent on others’ : South Asian patient experiences of haemodialysis

Shivani Sharma, Roisin Mooney, Andrew Davenport, Clara Day, Neil Duncan, David Wellsted, Maria Da Silva Gane, Kirit Modi, Ken Farrington, ‘‘I feel weak, useless and dependent on others’: South Asian patient experiences of haemodialysis’, poster presented at the Annual Conference British Renal Society, Leeds, UK, 30 June – 2 July, 2015.OBJECTIVE: Much of what is known about patient experiences of haemodialysis (HD) has been gleaned from research with White English speaking groups. People from South Asian backgrounds- originating from India, Pakistan and Bangladesh- have a three to five fold greater risk of needing treatment for renal failure. Owing to language and cultural barriers, less is known about how patients from specific ethnic minorities experience HD, although such knowledge would help shape efforts to provide suitable support. In this study, we invited those who communicate predominately or exclusively in Gujarati, Punjabi or Urdu to participate in focus groups and with the aim of exploring thoughts and feelings related to HD and its impact on day-to-day life. METHOD: Seven focus groups were held and across four NHS Trusts with high representation of patients from South Asian backgrounds. They were facilitated by a team of bilingual researchers with experience of working in healthcare contexts. Twenty-eight patients participated (15 males and 13 females; mean age 57.4 years). Focus groups were transcribed verbatim and translated into English, paying attention to retaining meaning as opposed to literal interpretation. Thematic Analysis was used to elucidate emerging themes, and using NVivo 10- a software programme designed to aid robust analysis of qualitative data. RESULTS: Patients reported numerous aspects of the ‘imposition of treatment’ that altered their sense of self and left them feeling as though they were ‘living in limbo’. Various ‘support mechanisms’ were seen as crucial in helping maintain some form of normality and these were both internally and externally derived. Hope for optimising outcomes was constrained by awareness of cultural barriers to ‘access to transplantation’ with patients’ conscious that their current situation added to ‘family stress’. Furthermore, perceptions of the ‘patient-clinician relationship’ often compounded the overall experience of HD- leaving the majority feeling trapped by their situation. CONCLUSION: Our findings highlight communalities in patient experiences of HD across different ethnic and cultural groups- delineating the aspects of treatment that patients struggle to contend with. Unique to our sample, we also expose concerns about access to kidney transplantation, with cultural factors limiting hope for improving quality of life. Targeted organ donation campaigns have a role to play here in furthering patient optimism for the future. It is apparent that patients require support in managing their altered sense of self and this can be facilitated in many ways including strengthening personal resources for coping alongside peer support.Peer reviewe

Prevalence of surgical procedures at symptomatic onset of prion disease

This case-control study examines the frequency of invasive procedures at the onset of prion disease symptoms to determine the scope of the risk of contamination to future patients

A orillas del río Samborombón. Primeros resultados del sitio arqueológico El Puesto (partido de Punta Indio, provincia de Buenos Aires, Argentina)

El Puesto archaeological site (Punta Indio, Buenos Aires province) is located at the Samborombón river lower basin, on a fluvial ridge adjacent to the floodplain. This paper presents the first results of the research carried out at the site and discusses the features of the archaeological record, the chronological information, and the postdepositional processes that affected it. El Puesto constitutes an unicomponent shallow site, with a minimum area of 350 m2. The evidence recovered up to a depth of 0.35 m consists mainly of ceramics and archaeofaunistic materials and to a lesser extent lithic remains, carbonized wood fragments, clay dough, and materials from historical moments (metal, glass, etc.). The heterogeneous nature of the traces identified in the remains indicates the complex formation of the archaeological record. A radiocarbon date of 260 ± 24 BP (1640-1800 cal. years) shows that El Puesto was occupied after the Hispanic-indigenous contact. Considering the characteristics of the area and its conditions of visibility and accessibility, similar to those of other archaeological contexts in the region, El Puesto can be provisionally defined as a hunter-gatherer multiple activities site, with sporadic and possibly recurring occupations. The scarcity of recovered materials could be linked to the sporadic nature of the represented occupation(s), to a highly mobile population dynamic, and/or to the post-depositional incidence of different agents. The analysis carried out indicates that the site would have been affected over time by the combined action of various post-depositional processes such as bioturbation, trampling, and hydric action.El sitio arqueológico El Puesto (partido de Punta Indio, provincia de Buenos Aires) está ubicado en la cuenca inferior del río Samborombón, en un albardón fluvial adyacente a la llanura de inundación. Este trabajo presenta los primeros resultados de las investigaciones realizadas en el sitio y discute las características del registro, la información cronológica y los procesos postdepositacionales que lo afectaron. El Puesto constituye un sitio somero unicomponente, con una superficie mínima de 350 m2. La evidencia recuperada hasta los 0,35 m de profundidad se compone principalmente de cerámica y materiales arqueofaunísticos, y en menor medida de elementos líticos, fragmentos de maderas carbonizadas, masas de arcilla y materiales de momentos históricos (metal, vidrio, etc.). El carácter heterogéneo de las huellas identificadas en los restos indica la compleja formación del registro arqueológico. Un fechado radiocarbónico de 260 ± 24 AP (1640-1800 años cal.) ubica a El Puesto en momentos poscontacto. Considerando las características del lugar y sus condiciones de visibilidad y accesibilidad, similares a las de otros contextos arqueológicos del área, El Puesto puede definirse provisoriamente como un sitio de actividades múltiples de cazadores-recolectores, de ocupación esporádica y posiblemente recurrente. La escasez de materiales recuperados podría estar vinculada al carácter ocasional de la o las ocupaciones representadas, a una dinámica poblacional de alta movilidad o bien a la incidencia posdepositacional de distintos agentes. Los análisis realizados indican que El Puesto habría sido afectado a lo largo del tiempo por la acción combinada de variados procesos postdepositacionales como la bioturbación, el pisoteo y la acción hídrica

Self-reported depression symptoms in haemodialysis patients: Bi-factor structures of two common measures and their association with clinical factors

Copyright © 2018 Elsevier Inc. All rights reserved.Objective: To validate the factor structure of two common self-report depression tools in a large sample of haemodialysis (HD) patients and to examine their demographic and clinical correlates, including urine output, history of depression and transplantation. Methods: Factor structures of the Beck Depression Inventory (BDI-II) and Patient Health Questionnaire (PHQ-9) were evaluated using confirmatory factor analysis (CFA). Data was utilised from the screening phase (n = 709) of a placebo-controlled feasibility randomised control trial (RCT) of sertraline in HD patients with mild to moderate Major Depressive Disorder. Alternative factor models including bi-factor models for the BDI-II and PHQ-9 were evaluated. Coefficient omega and omega-hierarchical were calculated. Results: For both measures, bi-factor measurement models had the overall best fit to the data, with dominant general depression factors. Omega-hierarchical for the general BDI-II and PHQ-9 factors was 0.94 and 0.88 respectively. Both general factors had high reliability (coefficient omega = 0.97 and 0.94 respectively) and explained over 85% of the explained common variance within their respective models. BDI-II and PHQ-9 general depression factors were negatively associated with age and urine output and positively with a history of depression, antidepressant use within the last 3 months and a history of failed transplantation. In adjusted regression models, age, urine output and a history of depression remained significant. Conclusions: These data suggest that both the BDI-II and PHQ-9 are sufficiently unidimensional to warrant the use of a total score. Younger age, lower urine output and a history of depression appear consistent correlates of depression severity among HD patients.Peer reviewedFinal Accepted Versio

On the shores of Samborombón river. First results of El Puesto archaeological site (Punta Indio, Buenos Aires province, Argentina)

El sitio arqueológico El Puesto (partido de Punta Indio, provincia de Buenos Aires) está ubicado en la cuenca inferior del río Samborombón, en un albardón fluvial adyacente a la llanura de inundación. Este trabajo presenta los primeros resultados de las investigaciones realizadas en el sitio y discute las características del registro, la información cronológica y los procesos postdepositacionales que lo afectaron. El Puesto constituye un sitio somero unicomponente, con una superficie mínima de 350 m2. La evidencia recuperada hasta los 0,35 m de profundidad se compone principalmente de cerámica y materiales arqueofaunísticos, y en menor medida de elementos líticos, fragmentos de maderas carbonizadas, masas de arcilla y materiales de momentos históricos (metal, vidrio, etc.). El carácter heterogéneo de las huellas identificadas en los restos indica la compleja formación del registro arqueológico. Un fechado radiocarbónico de 260 ± 24 AP (1640-1800 años cal.) ubica a El Puesto en momentos poscontacto. Considerando las características del lugar y sus condiciones de visibilidad y accesibilidad, similares a las de otros contextos arqueológicos del área, El Puesto puede definirse provisoriamente como un sitio de actividades múltiples de cazadores-recolectores, de ocupación esporádica y posiblemente recurrente. La escasez de materiales recuperados podría estar vinculada al carácter ocasional de la o las ocupaciones representadas, a una dinámica poblacional de alta movilidad o bien a la incidencia posdepositacional de distintos agentes. Los análisis realizados indican que El Puesto habría sido afectado a lo largo del tiempo por la acción combinada de variados procesos postdepositacionales como la bioturbación, el pisoteo y la acción hídrica.El Puesto archaeological site (Punta Indio, Buenos Aires province) is located at the Samborombón river lower basin, on a fluvial ridge adjacent to the floodplain. This paper presents the first results of the research carried out at the site and discusses the features of the archaeological record, the chronological information, and the postdepositional processes that affected it. El Puesto constitutes an unicomponent shallow site, with a minimum area of 350 m2 . The evidence recovered up to a depth of 0.35 m consists mainly of ceramics and archaeofaunistic materials and to a lesser extent lithic remains, carbonized wood fragments, clay dough, and materials from historical moments (metal, glass, etc.). The heterogeneous nature of the traces identified in the remains indicates the complex formation of the archaeological record. A radiocarbon date of 260 ± 24 BP (1640-1800 cal. years) shows that El Puesto was occupied after the Hispanic-indigenous contact. Considering the characteristics of the area and its conditions of visibility and accessibility, similar to those of other archaeological contexts in the region, El Puesto can be provisionally defined as a hunter-gatherer multiple activities site, with sporadic and possibly recurring occupations. The scarcity of recovered materials could be linked to the sporadic nature of the represented occupation(s), to a highly mobile population dynamic, and/or to the post-depositional incidence of different agents. The analysis carried out indicates that the site would have been affected over time by the combined action of various post-depositional processes such as bioturbation, trampling, and hydric action.Facultad de Ciencias Naturales y Muse

Sertraline Versus Placebo in Patients with Major Depressive Disorder Undergoing Hemodialysis : A Randomized, Controlled Feasibility Trial

This document is the Accepted Manuscript version of the following article: Karin Friedli, et al, ‘Sertraline Versus Placebo in Patients with Major Depressive Disorder Undergoing Hemodialysis: A Randomized, Controlled Feasibility Trial’, Clinical Journal of the American Society of Nephrology, Vol. 12 (2): 280-286, February 2017. The final, published version is available online at DOI: https://doi.org/10.2215/​CJN.02120216.BACKGROUND AND OBJECTIVES: Depression is common in patients on hemodialysis, but data on the benefits and risks of antidepressants in this setting are limited. We conducted a multicenter, randomized, double-blind, placebo-controlled trial of sertraline over 6 months in patients on hemodialysis with depression to determine study feasibility, safety, and effectiveness. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients on hemodialysis at five United Kingdom renal centers completed the Beck Depression Inventory II. Those scoring ≥16 and not already on treatment for depression were invited to undergo diagnostic interview to confirm major depressive disorder. Eligible patients with major depressive disorder were randomized to receive the study medication-either sertraline or placebo. Outcomes included recruitment and dropout rates, change in the Montgomery-Asberg Depression Rating Scale and Beck Depression Inventory II, and qualitative information to guide design of a large-scale trial. RESULTS: In total, 709 patients were screened and enrolled between April of 2013 and October of 2014; 231 (32.6%) had Beck Depression Inventory II scores ≥16, and 68 (29%) of these were already receiving treatment for depression. Sixty-three underwent diagnostic interview, 37 were diagnosed with major depressive disorder, and 30 were randomized; 21 completed the trial: eight of 15 on sertraline and 13 of 15 on placebo (P=0.05). Dropouts due to adverse and serious adverse events were greater in the sertraline group. All occurred in the first 3 months. Over 6 months, depression scores improved in both groups. Beck Depression Inventory II score fell from 29.1±8.4 to 17.3±12.4 (P<0.001), and Montgomery-Asberg Depression Rating Scale score fell from 24.5±4.1 to 10.3±5.8 (P<0.001). There were no differences between sertraline and placebo groups. CONCLUSIONS: Although small, this is the largest randomized trial to date of antidepressant medication in patients on hemodialysis. Our results highlight recruitment issues. No benefit was observed, but trial size and the substantial dropout render consideration of benefit inconclusive. A definitive trial could use shorter follow-up and include depressed patients already taking antidepressants.Peer reviewedFinal Accepted Versio