Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study

OBJECTIVE: The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia. STUDY SETTING AND DESIGN: Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings-diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia. PARTICIPANTS: A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian. DATA COLLECTION: Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records. PRINCIPAL FINDINGS: Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward. CONCLUSIONS: Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control

The experience of “medicine companions” to support adherence to antiretroviral therapy: quantitative and qualitative data from a trial population in Uganda

Good adherence is critical for antiretroviral therapy (ART) in sub-Saharan Africa. We report on the characteristics of medicine companions (MCs) chosen by Ugandan patients enrolling on ART, and on how MCs were chosen, and what roles they played. Baseline data on MCs of 1453 participants in a randomized controlled trial comparing facility and home-based delivery of ART in Jinja, Uganda were analyzed. Textual data on experience with MCs were collected through in-depth interviews among a subsample of 40 trial participants equally divided by sex and trial arm. Significantly more women (71%) than men (29%) were recruited. The majority (75%) of women participants were either widowed (51%) or separated or divorced (24%), whereas most of the men (66%) were married. Women were most likely to choose a child as their MC while men were most likely to choose their spouse; 41% of women chose an MC under 21 compared with only 14% of men. Only 31% of married women chose their husband, compared with 66% of married men who chose their wife. Qualitative interviews suggested MCs proved useful for reminding and other supportive tasks in the first three months but were generally less essential by six months and beyond. Convenience, reliability, and trust were key considerations in choosing an MC. Children provided the only alternative for many unmarried women, but even some married women felt children made more reliable MCs than husbands. Participants who had disclosed their serostatus usually received drug-taking reminders from multiple household members. One participant in the qualitative sample with poor family relations delayed starting treatment due to unwillingness to identify an MC. MCs were generally welcome and useful in supporting early adherence. However, disclosure to an MC should not be a condition of obtaining treatment

Assembléias de Formicidae epigéas no entorno do Parque Nacional da Chapada Diamantina, Bahia, Brasil

Ants at four localities were studied in the surroundins of the National Park of Chapada Diamantina, central region of the State of Bahia, Brazil. Vegetation belongs to the Atlantic forest biome (Sazonal Semideciduous Forest), but it is regionally surrounded by other vegetation formations, mainly of the caatinga and altitude field biomes. In each one of the four areas, 50 samples of ants were collected with a Winkler extractor and anoother 50 with pitfall traps. A total of 191 species distributed in 47 genera was found. The Winkler trap was most efficient in species capture. The communities of the two areas closer to the National Park, at Lençois presented greater similarity between themselves and larger species number, perhaps because they had been less used by humans in the last 40 years, than the two other areas studied, situated in farms and more distant to the Park. The comparative analysis of the similarity indices, calculated from the capture results obtained with the pit-fall traps and Winkler extractor, indicates that the two trees made from the results of all four areas are identical. Although this result was unexpected, it shows that whatever the collection method and the fauna segment studied, the relative similarity between series is respected. If this observation is verified under additional experimental conditions and biomes, it indicates that if the purpose is to use ants as bioindicators, several sampling techniques can be indiscriminately used for the comparative evaluation of ant assemblages, even if different strata are sampled for their fauna, with no impact on the conclusions that can be drawn about their characteristics of degradation or conservation.Foram realizadas coletas de Formicidae em quatro localidades situadas no entorno do Parque Nacional da Chapada Diamantina, região central do Estado da Bahia. A vegetação pertence ao bioma Mata Atlântica (Floresta Estacional Semidecidual), mas é regionalmente circundada por outras formações vegetais, sobretudo dos biomas caatinga e campo rupestre. Em cada uma das quatro áreas, foram coletadas 50 amostras de formigas da serapilheira com o extrator de Winkler e outros 50, com armadilhas de tipo pitfall. Foi encontrado um total de 191 espécies, distribuídas em 47 gêneros. A armadilha de Winkler foi a mais eficiente na captura de espécies. As comunidades das duas áreas situadas mais próximas ao Parque Nacional, em Lençóis, foram as que apresentaram maior similaridade entre si e maior número de espécies, talvez porque foram menos utilizadas pelo homem nos últimos 40 anos do que as duas outras áreas estudadas, situadas em fazendas mais distantes do Parque. A análise comparativa dos índices de similaridade, calculados a partir dos resultados das capturas realizadas com as armadilhas pit-fall e extrator de Winkler, indica que os dois agrupamentos relativos às quatro áreas estudadas são estritamente iguais. Apesar de esse resultado ser surpreendente, ele mostra que, qualquer que seja o método de coleta, isto é, o segmento de fauna amostrada, a similitude relativa entre series amostrais é respeitada. Se essa colocação se verificar em outras condições experimentais e outros biomas, ela indica que, em caso de uso das formigas como indicadores biológicos, diversas metodologias de amostragens poderiam ser indiscriminadamente utilizadas na avaliação comparativa de assembléias de Formicidae, mesmo se forem estudados estratos da fauna diferentes, sem prejuízo das conclusões que podem ser retiradas sobre as características de degradação ou de conservação de cada uma

Buccal alterations in diabetes mellitus

Long standing hyperglycaemia besides damaging the kidneys, eyes, nerves, blood vessels, heart, can also impair the function of the salivary glands leading to a reduction in the salivary flow. When salivary flow decreases, as a consequence of an acute hyperglycaemia, many buccal or oral alterations can occur such as: a) increased concentration of mucin and glucose; b) impaired production and/or action of many antimicrobial factors; c) absence of a metalloprotein called gustin, that contains zinc and is responsible for the constant maturation of taste papillae; d) bad taste; e) oral candidiasis f) increased cells exfoliation after contact, because of poor lubrication; g) increased proliferation of pathogenic microorganisms; h) coated tongue; i) halitosis; and many others may occur as a consequence of chronic hyperglycaemia: a) tongue alterations, generally a burning mouth; b) periodontal disease; c) white spots due to demineralization in the teeth; d) caries; e) delayed healing of wounds; f) greater tendency to infections; g) lichen planus; h) mucosa ulcerations. Buccal alterations found in diabetic patients, although not specific of this disease, have its incidence and progression increased when an inadequate glycaemic control is present

Engaging community pharmacists in the primary prevention of cardiovascular disease: protocol for the Pharmacist Assessment of Adherence, Risk and Treatment in Cardiovascular Disease (PAART CVD) pilot study

Background: Cardiovascular disease (CVD) is the leading cause of death globally. Community pharmacist intervention studies have demonstrated clinical effectiveness for improving several leading individual CVD risk factors. Primary prevention strategies increasingly emphasise the need for consideration of overall cardiovascular risk and concurrent management of multiple risk factors. It is therefore important to demonstrate the feasibility of multiple risk factor management by community pharmacists to ensure continued currency of their role.Methods/Design: This study will be a longitudinal pre- and post-test pilot study with a single cohort of up to 100 patients in ten pharmacies. Patients aged 50-74 years with no history of heart disease or diabetes, and taking antihypertensive or lipid-lowering medicines, will be approached for participation. Assessment of cardiovascular risk, medicines use and health behaviours will be undertaken by a research assistant at baseline and following the intervention (6 months). Validated interview scales will be used where available. Baseline data will be used by accredited medicines management pharmacists to generate a report for the treating community pharmacist. This report will highlight individual patients&rsquo; overall CVD risk and individual risk factors, as well as identifying modifiablehealth behaviours for risk improvement and suggesting treatment and behavioural goals. The treating community pharmacist will use this information to finalise and implement a treatment plan in conjunction with the patient and their doctor. Community pharmacists will facilitate patient improvements in lifestyle, medicines adherence, and medicines management over the course of five counselling sessions with monthly intervals. The primary outcome will be the change to average overall cardiovascular risk, assessed using the Framingham risk equation.Discussion: This study will assess the feasibility of implementing holistic primary CVD prevention programs into community pharmacy, one of the most accessible health services in most developed countries.<br /

Inhibition of the Progesterone Nuclear Receptor during the Bone Linear Growth Phase Increases Peak Bone Mass in Female Mice

Augmentation of the peak bone mass (PBM) may be one of the most effective interventions to reduce the risk of developing osteoporosis later in life; however treatments to augment PBM are currently limited. Our study evaluated whether a greater PBM could be achieved either in the progesterone nuclear receptor knockout mice (PRKO) or by using a nuclear progesterone receptor (nPR) antagonist, RU486 in mice. Compared to their wild type (WT) littermates the female PRKO mice developed significantly higher cancellous and cortical mass in the distal femurs, and this was associated with increased bone formation. The high bone mass phenotype was partially reproduced by administering RU486 in female WT mice from 1–3 months of age. Our results suggest that the inhibition of the nPR during the rapid bone growth period (1–3 months) increases osteogenesis, which results in acquisition of higher bone mass. Our findings suggest a crucial role for progesterone signaling in bone acquisition and inhibition of the nPR as a novel approach to augment bone mass, which may have the potential to reduce the burden of osteoporosis

The terrain of urbanisation process and policy frameworks: A critical analysis of the Kampala experience

Kampala is urbanising in an unplanned manner, but without a clear picture of the underlying dynamics. The city is characterised by lack of proper zoning of economic activities and construction of physical infrastructure without regard to subsequent spatial quality and environmental conservation. Consequently, there are sharp differences in residential standards where expensive housing and luxury flats co-exist with shanty towns and informal settlements, with about 60% of the city’s population living in unplanned informal settlements and often faced with challenges of unemployment. The unprecedented increase in the urban population in Kampala and the prospects for further increases in the near future have economic and social implications concerning employment, housing, education and health, among others. Understanding the nature of the dynamics of the growth or decline of cities like Kampala helps planners to support the processes that lead to harmonious urban development and to deal with the negative consequences of urban growth. This paper reflects the urbanisation dynamics explaining Kampala’s urbanisation process with the view to analysing the implications for an alternative urban policy framework. It argues that the conditions that have allowed the situation to exist have serious policy implications which require the need for an integrated policy framework that can be used to effectively prevent or halt Kampala’s unplanned urbanisation while promoting planned urbanisation. Induced by the migration and lack of information, understanding urban dynamics is crucial to the development of urban policies that can effectively ensure that further urban changes occur in a systematic and satisfactory manner. The current urban process in developing countries like Uganda is associated with poverty, environmental degradation and population demands that outstrip service capacity

Grand challenges in entomology: Priorities for action in the coming decades

Entomology is key to understanding terrestrial and freshwater ecosystems at a time of unprecedented anthropogenic environmental change and offers substantial untapped potential to benefit humanity in a variety of ways, from improving agricultural practices to managing vector-borne diseases and inspiring technological advances. We identified high priority challenges for entomology using an inclusive, open, and democratic four-stage prioritisation approach, conducted among the membership and affiliates (hereafter ‘members’) of the UK-based Royal Entomological Society (RES). A list of 710 challenges was gathered from 189 RES members. Thematic analysis was used to group suggestions, followed by an online vote to determine initial priorities, which were subsequently ranked during an online workshop involving 37 participants. The outcome was a set of 61 priority challenges within four groupings of related themes: (i) ‘Fundamental Research’ (themes: Taxonomy, ‘Blue Skies’ [defined as research ideas without immediate practical application], Methods and Techniques); (ii) ‘Anthropogenic Impacts and Conservation’ (themes: Anthropogenic Impacts, Conservation Options); (iii) ‘Uses, Ecosystem Services and Disservices’ (themes: Ecosystem Benefits, Technology and Resources [use of insects as a resource, or as inspiration], Pests); (iv) ‘Collaboration, Engagement and Training’ (themes: Knowledge Access, Training and Collaboration, Societal Engagement). Priority challenges encompass research questions, funding objectives, new technologies, and priorities for outreach and engagement. Examples include training taxonomists, establishing a global network of insect monitoring sites, understanding the extent of insect declines, exploring roles of cultivated insects in food supply chains, and connecting professional with amateur entomologists. Responses to different challenges could be led by amateur and professional entomologists, at all career stages. Overall, the challenges provide a diverse array of options to inspire and initiate entomological activities and reveal the potential of entomology to contribute to addressing global challenges related to human health and well-being, and environmental change