Environmental health perceptions of urban youth from low-income communities: A qualitative photovoice study and framework.

BACKGROUND: Children are amongst the most susceptible groups to environmental exposures, for both immediate and life-course health outcomes. Despite their increased susceptibility, children's knowledge, experiences and voices are understudied. A deeper understanding of children's environmental health perceptions has the potential to better inform policy, develop targeted interventions and improve public health outcomes. METHODS: In this study, our community-academic partnership used the Photovoice research method to examine how urban children from low-income communities perceive environmental influences on their health. Twenty children, ages 10-12, took photographs and participated in focus group interviews regarding their perspectives on how the environment influences their health. RESULTS: Qualitative analyses revealed five major thematic categories: environmental exposures, environmental health sentiments, environmental health outcomes, interest in environmental health and environmental health solutions. We used the findings to develop an environmental health perspective theoretical framework that can inform future work designed to promote the environmental health and well-being of children from low-income communities in urban communities. CONCLUSION: Photovoice enabled children from low-income communities to capture and communicate their environmental health perceptions. These findings have the potential to inform and identify potential targets and opportunities for environmental health interventions and promotion in their communities. PATIENT OR PUBLIC CONTRIBUTION: Partnerships with community-based organizations were central to the present study. By design, these community-based partners were involved in the conduct and procedures of the study.

Crisis: The Emergence of Another Hazardous Concept.

There are three ways that technology may be woven into the pattern of history: as the basis for sustainability, for progress, and for crisis. Currently historians are exploring all three patterns. Their approaches relate in some degree to different audiences, which include not only other historians but also engineers, social scientists, policy makers, and the wider public. This essay focuses on the historical pattern of crisis, a concept that is currently evolving from the older idea of a sharply defined turning point to one of ongoing, ever-spreading centers of doom. Fear that history might become a series of technology-driven crises coexists with continuing enthusiasm about history as technology-driven progress. What needs more attention is the possibility of providing, through material and social means, a historical basis for sustainable security.

Negotiating the practical ethics of 'self-tracking' in intimate relationships: Looking for care in healthy living.

In this paper, we offer insights into practices of tracking as part of healthy living through talk about home blood pressure and weight from adults living in the UK. Drawing on theoretical resources from feminist ethics of care and Science and Technology Studies on care as socio-material practice, we build on interest in the relational dimensions of tracking and the potential for intimate surveillance and care using monitoring technologies. Our cases offer not only new perspectives in a field that has often focused on fitness tracking but also help go beyond a narrow focus on surveillance, showing how surveillance and care may be intertwined in the everyday negotiation of health-related tracking and other 'health practices' in family life. Using the diversity in our relatively large sample, and reflecting on the different types of interview completed, we highlight the varied ways in which adults engage with tracking blood pressure and weight (or body mass index) in the context of established relationships. The combination of attentiveness and appeals to responsibility for maintaining health as something owed to a partner can make tracking a very ethically sensitive area. In this paper we emphasise that reciprocity is one important way in which couples make tracking feel more like care. Tracking together or discussing it can take couples in this direction even if the actual practice remains somewhat difficult. On the other hand, responsiveness to someone else's feelings, including a desire to avoid the topic altogether, or avoid weight as a specific parameter, might all help move towards more caring tracking. We therefore develop a more sustained account of care in relation to tracking than in previous work, and a novel account of tracking as a (potential) care practice between adult partners.

Cord blood banking - bio-objects on the borderlands between community and immunity.

Umbilical cord blood (UCB) has become the focus of intense efforts to collect, screen and bank haematopoietic stem cells (HSCs) in hundreds of repositories around the world. UCB banking has developed through a broad spectrum of overlapping banking practices, sectors and institutional forms. Superficially at least, these sectors have been widely distinguished in bioethical and policy literature between notions of the 'public' and the 'private', the commons and the market respectively. Our purpose in this paper is to reflect more critically on these distinctions and to articulate the complex practical and hybrid nature of cord blood as a 'bio-object' that straddles binary conceptions of the blood economies. The paper draws upon Roberto Esposito's reflections on biopolitics and his attempt to transcend the dualistic polarisations of immunity and community, or the private and the public. We suggest that his thoughts on immunitary hospitality resonate with many of the actual features and realpolitik of a necessarily internationalised and globally distributed UCB 'immunitary regime'.

Do hemodialysis patients prefer renal-specific or standard oral nutritional supplements?

OBJECTIVE: We investigated whether hemodialysis (HD) patients prefer standard or renal-specific oral nutritional supplements (ONS). DESIGN: Standard ONS Fortisip (Nutricia Clinical Care, Wiltshire, Trowbridge, UK) and renal ONS Renilon (Nutricia Clinical Care) and Nepro (Abbott Laboratories, Ltd., Maidenhead, Berkshire, UK) were compared using single-blind taste tests and face-to-face, interviewer-administered questionnaires. SETTING: This study took place in our HD unit in September 2007. PATIENTS: There were 40 patients, including 24 males, 14 smokers, and 26 Caucasians, aged <30 years (n = 6), 31 to 50 years (n = 13), 51 to 70 years (n = 12), and >70 years (n = 9). INTERVENTION: Patients ranked ONS taste on a Likert scale (1 to 5), and compared flavor options, phosphate-binder requirements, and fluid contribution. MAIN OUTCOME MEASURE: Which factors influenced a patient's choice of ONS? RESULTS: Gender, smoking status, ethnicity, and age influenced patients' choices. The taste of Fortisip and Nepro was liked by 58% (n = 23), versus 28% liking Renilon (n = 11). Renilon was disliked by 35% (n = 14), Nepro was disliked by 30% (n = 12), and Fortisip was disliked by 25% (n = 10). The favorite taste was Fortisip, in 52% (n = 21). However, 21% (n = 4) who preferred the taste of renal ONS would not choose them long-term because of their limited flavor ranges. The lack of phosphate binders with Renilon was a deciding factor in 27% (n = 19/33). The low fluid contribution of renal ONS influenced the choice of 43% (n = 12/28). All factors considered, standard ONS remained most popular for patients aged >70 years. However, in all other subgroups, and particularly males and non-Caucasians, renal ONS became more popular. Many patients (23%; n = 9) would sacrifice taste for the benefits of renal ONS. CONCLUSIONS: Renal ONS are more popular in HD patients because of their low fluid contribution and phosphate-binder requirements, which can influence preference over taste. Patients need information to make informed choices.

Nutritional management of patients undergoing surgery following diagnosis with encapsulating peritoneal sclerosis.

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). Gastrointestinal (GI) symptoms affect appetite and dietary intake. Adequate nutrition is especially important if surgical interventions are required. AIM: To investigate the nutritional management of 23 EPS patients that underwent surgical intervention between 1999 and 2005 at Manchester Royal Infirmary, United Kingdom. METHODS: EPS was recognized by GI symptoms and diagnostically confirmed by laparotomy, computed tomographic scanning, or biopsy. RESULTS: Mean time on PD was 74 months (interquartile range 42-89 months). During the 12 months pre-diagnosis, 65% of the group showed significant weight loss (p = 0.0001), with 8 patients losing >10% of body weight; 74% of patients experienced significant albumin decrease (p = 0.001); and 56% of patients experienced GI symptoms during the 6 months pre-diagnosis. Nasogastric (NG) feeding was recommended for 8 patients but continued in only 1. 15 patients (mean albumin 27 g/L) commenced parenteral nutrition (PN); 9 patients recovered, with albumin increasing over the 6-month follow-up. Mean hospital time was 62 days for the group receiving neither NG nor PN, compared with 124.3 for the PN/NG group (p = 0.04). In patients that died of EPS, albumin continued to fall at 3 months post-diagnosis. CONCLUSION: There is currently little guidance for nutritional management of EPS. From this study we recommend (1) a high level of clinical suspicion for EPS, especially if PD patients have weight loss; (2) PN may be better than NG feeding but further studies into dual enteral nutrition and PN are needed; (3) aggressive nutritional supplementation pre- and postoperatively; and (4) dietitians need to recognize the high risk of refeeding syndrome.

Encapsulating peritoneal sclerosis following renal transplantation despite tamoxifen and immunosuppressive therapy.

Encapsulating peritoneal sclerosis (EPS) is a rare disease in patients who have undergone peritoneal dialysis (PD). We report a case of EPS following renal transplantation that highlights important clinical issues. Initially, a presumptive diagnosis of EPS was made following surgical and pathological findings at the time of cholecystectomy. CT imaging at this time did not confirm the diagnosis. The patient continued PD and commenced tamoxifen. Prior to and immediately following transplantation, further CT imaging demonstrated no evidence of EPS. Acute bowel obstruction occurred 5 months post-transplantation and a diagnosis of EPS was made both clinically and on CT imaging, despite immunosuppression and tamoxifen. The role of these therapies in managing EPS post-transplant is discussed, in addition to the need for a high index of clinical suspicion to make the diagnosis.