Understanding processes of social exclusion : silence, silencing and shame

Not availabl

Getting older and living longer with HIV: Findings from a pilot study conducted in Newham

Presentation given at UEL Research and Knowledge Exchange Conference 2012, held at the University of East London on 3 May 2012

Examining the Notion of Informed Consent and Lessons Learned for Increasing Inclusion Among Marginalised Research Groups

This chapter examines some of the barriers to obtaining informed consent to participate in research studies from those who are deemed vulnerable, disadvantaged, marginalised and underrepresented in research. First, the chapter examines the underlying principles of informed consent, before examining the challenges presented by formalised and regulated informed consent procedures in contexts in which data collection processes are fluid and potential research participants have differing needs. Finally, the chapter examines the notions of trust and researcher responsibility and their significance for negotiating and maintaining a non-formalised form of consent. We argue that these procedures serve to enhance, rather than diminish, participant autonomy.In order to illustrate the challenges and solutions of obtaining informed consent, we present research carried out with a group of predominately African migrants aged 50 and older, and living with HIV in a socio-economically disadvantaged area of East London, UK. We examine the challenges presented by utilising standardised, informed consent procedures, by which respondents to an anonymous questionnaire and participants in a series of focus group discussions were required to give written and signed consent. The case study illustrates how underlying assumptions about the nature and acceptability of approaches to verifying consent for research participation can exclude or include participation from populations who are typically excluded for research. Here, adults with uncertain immigration status, poor literacy, poor English language, poor mental and physical health, felt stigmatised or suspicious of the consenting requirements. Drawing on our experiences, we argue that the model of written informed consent, in some cases can and where possible, should be exchanged for other forms of informed consent such as implied consent in order to include groups that we often know the least about, such as marginalised groups

Theorising stigma and the experiences of injecting drug users in Australia

This paper examines the stigma of injecting drug use as an underlying factor in the poor health status ofAustralian injecting drug users. Drawing on various models of stigma described in the literature, we examine injecting drug users&rsquo; experiences. As a case study, examples from Victorian (specifically Melbourne) policy and practice are included to exemplify community and societal attitudes towards injecting drug users and the implications of these for injecting drug user health. We conclude that redressing the negative effects of stigma requires political will, financial support, increased community commitment and a better understanding of the links between the social determinant of health and the poor health status of injecting drug users.Without reducing the stigma of injecting drug use the health of this marginalised population is likely to get worse, which will have broader negative population health effects.<br /

Obstructive sleep apnoea and diabetes: an update.

PURPOSE OF REVIEW The relationship between obstructive sleep apnoea (OSA) and dysglycaemia is well established. However, uncertainty remains as to the extent that obesity mediates this relationship. The impact of OSA treatment on glucose metabolism and the consequences of having OSA in patients with diabetes is unclear. This review aims to summarize the latest evidence regarding the links between OSA and dysglycaemia. RECENT FINDINGS OSA is associated with insulin resistance in lean individuals and predicts insulin resistance worsening longitudinally. Continuous positive airway pressure (CPAP) lowers insulin resistance in CPAP-compliant patients. OSA is associated with impaired β-cell function. In patients with type 2 diabetes (T2D), the association between OSA and glycosylated haemoglobin (HbA1c) is related to nocturnal hypoxaemia. Apnoea hypopnoea index (AHI) during rapid eye movement (REM) (not non-REM) sleep is associated with HbA1c. In-laboratory, supervised CPAP improves glycaemia. OSA is associated with and predicts the progression of some diabetic vascular complications. Intensive lifestyle intervention in patients with T2D improves OSA independent of weight loss. SUMMARY OSA is associated with insulin resistance and β-cell dysfunction independent of obesity. OSA is associated with HbA1c and vascular complications in patients with T2D. CPAP might improve insulin resistance and glycaemic measures. Lifestyle intervention has a significant impact on AHI in patients with T2D