Guyanese Women's Experiences of Invisibility in Health Care in England

This article explores the opportunities for strengthening participatory action research (PAR) through an intersectionality framework. In 2015, I completed a Ph.D. study into the lived experiences of migrant Guyanese women, living in England, when seeking diagnoses and treatment for Type 2 diabetes. Group storytelling acted as a lens for the women to talk about how they tried to obtain a diagnosis, in addition to their migratory experiences. Both PAR and intersectionality encourage participant collaboration and community engagement of oppressed groups. The article concludes that the PAR study would have been enhanced by overlaying it with an intersectionality framework. The argument is presented that by doing so the women's accounts in the research study would have been privileged more and activism encouraged in bringing about change to current practices and avoiding perpetuating existing oppressions. The Ph.D. study methodology was based on Koch's interpretation of PAR. In this, PAR is used where the focus is on participation of all stakeholders toward reform and change. It is seen as a social, practical and collaborative process where building relationships with participants is crucial. Intersectionality acknowledges the potential for “black” and other women of color to not remain on the margins but to challenge the traditional biomedical model of health care delivery. Implementing an intersectional approach to the data generation and analysis would have acknowledged power dynamics (i.e., privilege and oppression) and help to identify potential gaps in diabetic provision which are currently invisible or inequitable due to interventions designed to meet the needs of a homogeneous White middle class society

Depression and loneliness in Jamaicans with sickle cell disease

<p>Abstract</p> <p>Background</p> <p>Sickle cell disease (SCD) is the commonest genetic disorder in Jamaica, and has life-long implications for those afflicted with it. It is well known that depression and loneliness may exist in those with chronic diseases, but the coexistence of depression and loneliness in people with sickle cell disease is not clear. The aim of this study is to determine the prevalence of and factors associated with depression and loneliness in the Jamaica Sickle Cell Cohort Study and its age and sex matched controls.</p> <p>Methods</p> <p>277 patients with SCD and 65 controls were administered a questionnaire that studied demographics, disease severity, depression, and loneliness. Regression analyses were done to examine relationships between outcomes and associated variables.</p> <p>Results</p> <p>Depression was found in 21.6% of patients and 9.4% in controls. Loneliness scores were also significantly higher in patients (16.9 ± 5.1) than in controls (14.95 ± 4.69). Depression was significantly associated with unemployment [OR = 2.9, p-value: < 0.001], whereas unemployment (p-value: 0.002), and lower educational attainment were significantly associated with loneliness.</p> <p>In patients with SCD, depression was significantly associated with being unemployed (OR 2.4, 95% CI 1.2,4.6, p-value:0.01), presence of a leg ulcer (OR = 3.8, 95% CI: 1.7, 8.4, p-value: 0.001), frequent visits (OR = 3.3, 95% CI: 1.2, 8.9, p-value: 0.019), and frequent painful crises (OR = 2.5, 95% CI: 1.1, 5.8, p-value: 0.035). Not being employed (Coef.: 2.0; p-value: 0.004) and higher educational attainment (tertiary vs. primary education, Coef.: -5.5; p-value: < 0.001) were significant associations with loneliness after adjusting for genotype.</p> <p>Conclusions</p> <p>Health workers need to actively look for and manage these problems to optimize their patients' total biopsychosocial care.</p

Systematic Review of Potential Health Risks Posed by Pharmaceutical, Occupational and Consumer Exposures to Metallic and Nanoscale Aluminum, Aluminum Oxides, Aluminum Hydroxide and Its Soluble Salts

Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007). Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of “total Al”assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al+ 3 to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)+ 2 and Al(H2O)6 + 3] that after complexation with O2•−, generate Al superoxides [Al(O2•)](H2O5)]+ 2. Semireduced AlO2• radicals deplete mitochondrial Fe and promote generation of H2O2, O2 • − and OH•. Thus, it is the Al+ 3-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer\u27s disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances

Filling a niche in “ligand space” with bulky, electron-poor phosphorus (III) alkoxides

The chemistry of phosphorus(III) ligands, which are of key importance in coordination chemistry, organometallic chemistry and catalysis, is dominated by relatively electron-rich species. Many of the electron-poor P(III) ligands that are readily available have relatively small steric profiles. As such, there is a significant gap in “ligand space” where more sterically bulky, electron-poor P(III) ligands are needed. This contribution discusses the coordination chemistry, steric and electronic properties of P(III) ligands bearing highly fluorinated alkoxide groups of the general form PRn(ORF)3-n, where R = Ph, RF = C(H)(CF3)2 and C(CF3)3; n = 1-3. These ligands are simple to synthesize and a range of experimental and theoretical methods suggest that their steric and electronic properties can be “tuned” by modification of their substituents, making them excellent candidates for large, electron-poor ligands

An Assessment of the Growth-Enhancing Size of Government in the Caribbean

Between 1990 and 1994, the average size of the public sector in the Caribbean was just 16 percent of GDP, in the five years hence, the ratio has climbed and currently stands at 22 percent of GDP. While an expansion in the size of government usually results in the greater provision of services, it can also lead to slower rates of growth because of greater bureaucracy and the crowding-out of private sector driven initiatives. Using a simple production function approach, this study provides an assessment of the growth-enhancing size of government in the Caribbean using annual observations for the period 1975 to 2002. The econometric results in the paper suggest that government services do positively influence growth, but only if the size of government is, on average, between 10 percent and 16 percent of total real value-added.

Synthesis and complexation of heptafluoroisopropyldiphenylphosphine (pub)

International audienc