The call to life: revitalizing a healthy Hawaiian identity

The meaning of health is typically defined as the absence of disease. This definition, while highlighting our ability to measure the physiological attributes of health through morbidity and mortality statistics in turn obscures alternative meanings of health. In this paper, I ask three questions about the meaning of health. First, is health simply the body without disease? Second, are there alternative meanings of health that are not solely informed by Enlightenment views of science and biomedicine? Third, in what ways does health give meaning to and inform social orders and our place within them? Drawing on interviews with Native Hawaiians conducted on the islands of Maui and Hawaii, this paper examines what it means to be a "healthy Hawaiian", and in doing so, problematizes meanings of health. For those I interviewed, definitions of health were embedded in understandings of what it means to be a Native Hawaiian and presented an opportunity to talk about the cultural and material dispossession of Native Hawaiians. These definitions also remind the present generation of the vitality of their ancestors. In remembering the life, health and subsequent dispossession of Hawaiian ancestors, contemporary Hawaiians are provided with an alternative definition of what it means to be a "healthy Hawaiian", thus raising serious questions about "health" as defined by biomedicine and how best to achieve it. This case illustrates how a focus on concepts of health elucidates the relationship between health and inequality as well as Native Hawaiian's agency in charting a positive direction for health that has meaning in the everyday life of Hawaiians.     

Sewage‐based epidemiology in monitoring the use of new psychoactive substances: Validation and application of an analytical method using LC‐MS/MS

Sewage‐based epidemiology (SBE) employs the analysis of sewage to detect and quantify drug use within a community. While SBE has been applied repeatedly for the estimation of classical illicit drugs, only few studies investigated new psychoactive substances (NPS). These compounds mimic effects of illicit drugs by introducing slight modifications to chemical structures of controlled illicit drugs. We describe the optimization, validation, and application of an analytical method using liquid chromatography coupled to positive electrospray tandem mass spectrometry (LC‐ESI‐MS/MS) for the determination of seven NPS in sewage: methoxetamine (MXE), butylone, ethylone, methylone, methiopropamine (MPA), 4‐methoxymethamphetamine (PMMA), and 4‐methoxyamphetamine (PMA). Sample preparation was performed using solid‐phase extraction (SPE) with Oasis MCX cartridges. The LC separation was done with a HILIC (150 x 3 mm, 5 µm) column which ensured good resolution of the analytes with a total run time of 19 min. The lower limit of quantification (LLOQ) was between 0.5 and 5 ng/L for all compounds. The method was validated by evaluating the following parameters: sensitivity, selectivity, linearity, accuracy, precision, recoveries and matrix effects. The method was applied on sewage samples collected from sewage treatment plants in Belgium and Switzerland in which all investigated compounds were detected, except MPA and PMA. Furthermore, a consistent presence of MXE has been observed in most of the sewage samples at levels higher than LLOQ. Copyright © 2015 John Wiley & Sons, Ltd.     

Through the looking glass: being a critical ethnographic researcher in a familiar nursing context

This article draws on the primary author's experiences of conducting a critical ethnographic study within the emergency department where she works. Extracts from her journal entries illustrate the tensions that emerged. These are theorised and discussed, resulting in a 'troubling' of the ethnographic field.     

Barriers to Caregiver Compliance with Eating and Drinking Recommendations for Adults with Intellectual Disabilities and Dysphagia

Background There is scant research on the subject of dysphagia and people with intellectual disabilities. This study explores the barriers which caregivers believe make following Speech and Language Therapists’ (SLTs) dysphagia management strategies more difficult. Method Semi‐structured open‐ended interviews were conducted with 46 caregivers who supported 40 intellectually disabled adults with dysphagia. Results Caregivers perceived particular difficulties in modifying food and drinks to safe consistencies, achieving the agreed positioning during mealtimes, and in using support and prompting strategies. Problematic support and prompting strategies included difficulties with pacing correctly; facilitating people to adequately relax and concentrate; observing and prompting people to pace suitably and take safe amounts of food and drink in each mouthful. Additional barriers identified included time pressures, staff turnover and insufficient reviewing of SLT management strategies by caregivers. Conclusions Findings suggest that additional training and monitoring is required to ensure caregivers are aware of their role and responsibility in promoting safe oral intake for adults with dysphagia and intellectual disabilities. Ongoing support is suggested for people with intellectual disabilities and dysphagia to help them understand the reasoning behind management strategies.     

Obesity and fractures in postmenopausal women

Low body mass index (BMI) is a recognized risk factor for fragility fracture, whereas obesity is widely believed to be protective. As part of a clinical audit of guidance from the National Institute of Health and Clinical Excellence (NICE), we have documented the prevalence of obesity and morbid obesity in postmenopausal women younger than 75 years of age presenting to our Fracture Liaison Service (FLS). Between January 2006 and December 2007, 1005 postmenopausal women aged less than 75 years with a low‐trauma fracture were seen in the FLS. Of these women, 805 (80%) underwent assessment of bone mineral density (BMD) by dual energy X‐ray absorptiometry (DXA), and values for BMI were available in 799. The prevalence of obesity (BMI 30 to 34.9 kg/m²) and morbid obesity (BMI ≥ 35 kg/m²) in this cohort was 19.3% and 8.4%, respectively. Normal BMD was reported in 59.1% of obese and 73.1% of morbidly obese women, and only 11.7% and 4.5%, respectively, had osteoporosis (p < .0001). Multiple regression analysis revealed significant negative associations between hip T‐score and age (p < .0001) and significant positive associations with BMI (p < .0001) and previous fracture (p = .001). Our results demonstrate a surprisingly high prevalence of obesity in postmenopausal women presenting to the FLS with low‐trauma fracture. Most of these women had normal BMD, as measured by DXA. Our findings have important public heath implications in view of the rapidly rising increase in obesity in many populations and emphasize the need for further studies to establish the pathogenesis of fractures in obese individuals and to determine appropriate preventive strategies. © 2010 American Society for Bone and Mineral Research