Inclusivity and decolonisation of the post-graduate public health curriculum: Reflections from a student-led approach.

The future of successful public health practice requires public health students to be educated within a decolonised curriculum that challenges the historical biases and inequalities that are deeply embedded within global public health and society. In this commentary, we reflect on what it can mean and why it's important to decolonise and diversify a public health curriculum. We describe how we used a student-led approach to begin this process, and share recommendations that are applicable to national and international curricula.

A qualitative exploration of the psychological impacts of living with the uncertainty of persistent flood risk.

OBJECTIVES: Flooding is associated with increased psychological morbidity; however, the impact of living with the uncertainty of flood risk has not been explored. The aim of this study was to generate insight into individual experiences of living with persistent flood risk, how it affects psychological well-being, and the forms of support deemed appropriate to mitigate psychological risks. STUDY DESIGN: A qualitative study was conducted using semistructured interviews with participants who lived in a persistent flood risk area in Nottinghamshire, UK. METHODS: 40 participants were interviewed. The study adopted an interpretivist constructionist position, and the transcripts were analysed using inductive thematic analysis. RESULTS: Persistent flood risk was seen as a significant stressor, regardless of previous flood history. Some participants reported anxiety in anticipation of a future flood event and demonstrated low self-efficacy, with subsequent feelings of helplessness in responding to flood risk. Individuals who lacked acceptance of flood risk displayed higher anxiety and lower resilience. Recognition of flood risk as a psychological stressor was requested in future support. CONCLUSIONS: Living with the uncertainty of persistent flood risk can have significant psychological impacts. Interventions that facilitate the empowerment of individuals living with persistent flood risk may strengthen psychological resilience.

What can be done to encourage women from Black, Asian and minority ethnic backgrounds to attend breast screening? A qualitative synthesis of barriers and facilitators.

OBJECTIVE: The objective of the study is to identify the barriers to UK Black, Asian and Minority Ethnic (BAME) women attending breast screening and subsequently, support the growing evidence base providing solutions to the public health problem of ethnic variation within screening attendance. STUDY DESIGN: A systematic review and thematic analysis of UK-based, qualitative studies concerning BAME women. METHODS: The methodology of this review is based on Cochrane guidelines. A search strategy was applied to Embase, PubMed and Medline. Predefined inclusion and exclusion criteria yielded 8 final articles which were appraised and thematically analysed. RESULTS: The main findings of the review revealed three overarching themes: knowledge-related, access-related and cultural-related factors. The emphasis of the importance of knowledge was highlighted by all studies identifying a lack of knowledge as a key barrier to screening attendance. CONCLUSIONS: BAME women have disproportionally lower breast screening attendance and a lack of knowledge is an essential barrier to overcome when addressing this health inequality.

Multiple mechanisms underlie displacement of solitary Hawaiian Hymenoptera by an invasive social wasp.

Variation in invasion success may result from the divergent evolutionary histories of introduced species compared to those of native taxa. The vulnerability of native biotas to ecological disruption may be especially great on oceanic islands invaded by continental species with unique ecological traits. In part because Hawaii lacks native eusocial insects, social invaders may threaten endemic taxa that are ecologically similar but solitary. Using a combination of field manipulations, molecular analyses, physiological data, and behavioral assays, we identify the mechanisms underlying the displacement of two genera of native solitary Hymenoptera in Hawaii by a social continental invader, the western yellowjacket (Vespula pensylvanica). Experimental removal of V. pensylvanica colonies resulted in increased densities of native Hymenoptera. Endemic Hylaeus bees directly suffer through predation by yellowjackets, and perhaps as a consequence, avoid floral resources occupied by V. pensylvanica. Native Nesodynerus wasps also avoid V. pensylvanica but are negatively affected by yellowjackets not through predation, but through exploitative competition for caterpillar prey. Displacement of native solitary Hymenoptera may be heightened by the ability of V. pensylvanica to prey upon and scavenge honey bees and to rob their honey stores, resources unavailable to endemic bees and wasps because of their specialized niches. Our study provides a unique example of an ecologically generalized social invader that restructures native assemblages of solitary Hymenoptera by interacting with endemic taxa on multiple trophic levels.

Yellowjackets (Vespula pensylvanica) thermoregulate in response to changes in protein concentration.

Social insects can modulate body temperature to increase foraging efficiency; however, little is known about how the relative value of protein resources affects forager body temperature. Such regulation may be important given that colony growth is often limited by protein availability. In this paper, we present what are, to our knowledge, the first data for social insects showing that thoracic temperatures (T (th)) of foragers increase with the protein content of food resources. In an introduced population of western yellowjacket (Vespula pensylvanica), we measured T (th) of foragers collecting high-quality protein (100% canned chicken) and low-quality protein (50% canned chicken, 50% indigestible alpha-cellulose by volume) at different ambient air temperatures (T (a)). Wasps foraging on 100% chicken consistently exhibited higher T (th) compared to wasps foraging on 50% chicken. After correcting for T (a), the mean T (th) for wasps collecting 100% chicken were 1.98 degrees C higher than those of individuals collecting 50% chicken. We suggest that this mechanism may increase foraging efficiency in this and other social wasp species.

The effect of gonadotropin-releasing hormone agonists on adrenocorticotropin and cortisol secretion in adult premenopausal women.

GnRH agonists are known to suppress LH, FSH, and subsequent ovarian estradiol production by down-regulation of pituitary gonadotropin receptors. Previous investigations have demonstrated that GnRH agonists also suppress GHRH-stimulated GH release in normal men and women and PRL levels in subjects with hyperprolactinemia. Little is known about the effects of GnRH agonists on the hypothalamic-pituitary-adrenal axis. The purpose of the present investigation was to determine the secretion of ACTH and cortisol after an iv infusion of hCRH in control women (n = 11) and in women undergoing treatment with GnRH agonists (n = 10). The plasma and serum levels of ACTH and cortisol increased after infusion of CRH in all women. The basal and CRH-stimulated plasma levels of ACTH and cortisol at each time point were not statistically different between GnRH agonist-treated women and controls. Thus, the chronic use of GnRH agonists is known to suppress the hypothalamic-pituitary-ovarian axis and is associated with GH and PRL suppression as well, but does not apparently alter the hypothalamic-pituitary-adrenal axis.

Laparoscopic removal of dysgenetic gonads containing a gonadoblastoma in a patient with Swyer syndrome.

Dysgenetic streak gonads were removed laparoscopically from a phenotypic female with Swyer syndrome (ie, XY karyotype, sexual infantilism, primary amenorrhea, and müllerian structures). Pathologic examination revealed a small (3 mm) gonadoblastoma in one of her gonads without evidence of malignant transformation. The patient tolerated the procedure well and was back at work the next day. We propose that laparoscopy is a safe, cost-effective, and simple procedure to perform on individuals requiring prophylactic gonadectomy for the prevention of neoplasia.

Effect of superovulation with human menopausal gonadotropins on growth hormone levels in women.

GH synthesis and secretion are influenced by several factors, including age, body weight, and sex steroid hormones. Endogenous and exogenous estrogens influence the circulating levels of GH. The purpose of the present investigation was to define the relationship between serum GH and estradiol levels during the follicular phase in women with normal ovulatory menstrual cycles compared with that in women undergoing superovulation with human menopausal gonadotropins (hMG) alone or hMG plus GnRH agonists during treatment for infertility. Serum GH and estradiol levels were determined by immunoassay in eight women during the follicular phase of a spontaneous natural cycle (group I). Thirty women underwent ovulation induction with hMG alone (group II), and 30 women received GnRH agonists followed by hMG (group III). During the follicular phase estradiol levels increased gradually in group I and reached a peak estradiol level of 1.19 +/- 0.2 nmol/L (mean +/- SEM). As expected, estradiol levels rose faster and reached higher levels in groups II and III (5.44 +/- 0.62 and 8.73 +/- 0.91 nmol/L, respectively). Whereas serum GH levels increased minimally in group I, reaching a peak level of 2.54 +/- 1.15 nmol/L, serum GH concentrations increased markedly after day 8 in groups II and III, reaching peak levels of 8.70 +/- 1.58 and 7.54 +/- 1.12 nmol/L, respectively (P less than 0.01). Basal to peak GH levels were higher in groups II and III than in group I. In summary, there are modest increases in GH levels during the follicular phase of the normal menstrual cycle, but the levels are markedly increased during superovulation with hMG or hMG plus GnRH agonists, and parallel increases in estradiol levels.

Vulvovaginal sequelae of Stevens-Johnson syndrome and their management.

We describe a woman with Stevens-Johnson syndrome, a life-threatening form of erythema multiforme characterized by bullae formation, extensive mucosal damage, and systemic toxicity, and known to be triggered by various drugs, infections, ingestants, or contactants. Serious complications have been reported in most body systems, including cases of permanent damage to the urogenital tract. Three methods of surgical treatment for severe vaginal complications, depending on the degree of vaginal mucosal damage, are described, including the successful treatment of our patient, who had vaginal adenosis, endometriosis, and severe stenosis from this disease. Methods of therapy are presented for possible prevention of severe vaginal sequelae from Stevens-Johnson syndrome.

Use of ultrasound scan in prostatic I-125 implantation.

The average dimension of prostate was measured by transabdominal ultrasonography preoperatively to compare with direct intraoperative measurements in 28 patients undergoing suprapubic I-125 seed implantation for the treatment of prostatic cancer. A highly significant correlation (r = 0.932) was found between these two measurements. Transabdominal ultrasonography is a relatively simple and accurate non-invasive method of determining the number of I-125 seeds needed to implant the patient with prostatic malignancy.

Pharmacists' role in smoking cessation.

"Time to quit", a program piloted in Winnipeg in 1983, is an example of the importance of the pharmacist in the smoking cessation issue. Through the Manitoba Pharmaceutical Association, pharmacies were utilized as distribution centres for a self-help smoking cessation booklet. In the city of Winnipeg, 82% of city pharmacies received a total of 40,500 books; 93.5% of these booklets were picked up by the public. Pharmacists also had the option to become more involved in the anti-smoking campaign if they so desired. Pharmacists not only have the knowledge to discuss the area of smoking cessation, they arein a strategic position for dissemination of that knowledge.

Use of ultrasonography in planning intracavitary radiotherapy of endometrial carcinoma.

A diagnostic ultrasound examination is a simple and reliable method of obtaining anatomical information for intracavitary irradiation of endometrial carcinoma of the uterus. Scanning before treatment to determine uterine size and shape assists in choosing the most appropriate applicator. Scanning after insertion of an afterloading applicator facilitates calculation of radiation doses at critical points within and on the surface of the uterus. Poor applicator position can also be detected. Diagnostic ultrasound examinations should be adopted as a routine procedure in establishing intracavitary irradiation programs for adenocarcinoma of the uterine fundus.