Colonising Safety: creating risk through the enforcement of biomedical constructions of safety.

In the normative health care discourse, safety is represented as a concept that is at once universal, irrefutable, and inherently beneficent. Yet, research at local levels in the Philippines challenges these assumptions embedded in the biomedical construction of safety. This article examines how the imposition of a biomedical construction of safety onto a given local group, which does not share this construction of safety, can affect the local group. Specifically, this article examines the application of the biomedical construction of safety to the regulation and control of local nonbiomedical practices and practitioners in the rural Philippines. This twenty-two-month field research was carried out through interviews, focus groups, and participant observation within communities of four rural municipalities in the Philippines and with stakeholders at state and multilateral levels. The case study of the implementation of safe delivery through the insistence on in-facility birthing with “skilled birth attendants” and the cessation of training for traditional birth attendants provides an illustrative example of the need for more nuanced and complex understandings of safety and risk within any given context. This research identifies that the enforcement of an etic conception of safety onto any given group can, ultimately, compromise the safety of that group.Global Challenges (FGGA

Identifying key influences on antibiotic use in China: a systematic scoping review and narrative synthesis

INTRODUCTION: The inappropriate use of antibiotics is a key driver of antimicrobial resistance. In China, antibiotic prescribing and consumption exceed recommended levels and are relatively high internationally. Understanding the influences on antibiotic use is essential to informing effective evidence-based interventions. We conducted a scoping review to obtain an overview of empirical research about key behavioural, cultural, economic and social influences on antibiotic use in China. METHODS: Searches were conducted in Econlit, Medline, PsycINFO, Social Science citation index and the Cochrane Database of Systematic Reviews for the period 2003 to early 2018. All study types were eligible including observational and intervention, qualitative and quantitative designs based in community and clinical settings. Two authors independently screened studies for inclusion. A data extraction form was developed incorporating details on study design, behaviour related to antibiotic use, influences on behaviour and information on effect (intervention studies only). RESULTS: Intervention studies increased markedly from 2014, and largely focused on the impact of national policy and practice directives on antibiotic use in secondary and tertiary healthcare contexts in China. Most studies used pragmatic designs, such as before and after comparisons. Influences on antibiotic use clustered under four themes: antibiotic prescribing; adherence to antibiotics; self-medicating behaviour and over-the-counter sale of antibiotics. Many studies highlighted the use of antibiotics without a prescription for common infections, which was facilitated by availability of left-over medicines and procurement from local pharmacies. CONCLUSIONS: Interventions aimed at modifying antibiotic prescribing behaviour show evidence of positive impact, but further research using more robust research designs, such as randomised trials, and incorporating process evaluations is required to better assess outcomes. The effect of national policy at the primary healthcare level needs to be evaluated and further exploration of the influences on antibiotic self-medicating is required to develop interventions that tackle this behaviour

The representation and practice of healthcare integration: alterity and the construction of healthcare integration in the Philippines

Non-biomedical practices and practitioners serve as the primary source of healthcare for a majority of populations in low-income countries. The World Health Organization (WHO) has prioritised the integration of local non-biomedical healthcare practices and practitioners into formal state healthcare systems since the Declaration of Alma Ata in 1978. Heretofore, both WHO's representation of healthcare integration and its discourse of beneficence have been reified, yet largely unexamined. This research examines the processes of healthcare integration through qualitative research at multiple levels of analysis in the Philippines to better understand: what healthcare integration is; how stakeholders perceive healthcare integration; and how the practice of healthcare integration may differ from its discursive representation. This research was conducted in communities of four municipalities of the Philippines over a period of 22 months. The sample of 1,023 informants consisted of community members, community leaders, healthcare providers, and policy actors who participated in semistructured interviews, focus groups, and pile sorts. Participant experience was also conducted over a year-long period in both the Traditional Medicine Unit of The Western Pacific Region Office of the WHO and the Philippine Institute of Traditional and Alternative Healthcare of the Department of Health of the Philippines. The integration of local birth attendants through prohibition of their practices serves as a case example. From this research, healthcare integration is understood as multiple independent and interdependent processes that occur simultaneously across global, state, and local levels of analysis, including the individual level. However, community level stakeholders were identified to resist healthcare integration practices, which they perceived as either inappropriate for their community and/or capable of compromising their access to healthcare. These findings are presented in terms of the development studies discourses concerning appropriate knowledge/technology transfer, community agency, complex adaptive systems, health reform and administrative decentralisation, and the relevance of subjectivity in development interventions.</p

Excess mortality in the aftermath of Hurricane Katrina: A preliminary report

Paul I. Kadetz - ORCID: 0000-0002-2824-1856 https://orcid.org/0000-0002-2824-1856Item not available in this repository.Background: Reports that death notices in the Times-Picayune, the New Orleans daily newspaper, increased dramatically in 2006 prompted local health officials to determine whether death notice surveillance could serve as a valid alternative means to confirm suspicions of excess mortality requiring immediate preventive actions and intervention. Methods: Monthly totals of death notices from the Times-Picayune were used to obtain frequency and proportion of deaths from January to June 2006. To validate this methodology the authors compared 2002 to 2003 monthly death frequency and proportions between death notices and top 10 causes of death from state vital statistics. Results: A significant (47%) increase in proportion of deaths was seen compared with the known baseline population. From January to June 2006, there were on average 1317 deaths notices per month for a mortality rate of 91.37 deaths per 100,000 population, compared with a 2002–2004 average of 924 deaths per month for a mortality rate of 62.17 deaths per 100,000 population. Differences between 2002 and 2003 death notices and top 10 causes of death were insignificant and had high correlation. Discussion: Death notices from local daily newspaper sources may serve as an alternative source of mortality information. Problems with delayed reporting, timely analysis, and interoperability between state and local health departments may be solved by the implementation of electronic death registration. (Disaster Med Public Health Preparedness. 2007;1:15–20)https://doi.org/10.1097/DMP.0b013e31806918561pubpub