Staphylococcus aureus screening and preoperative decolonisation with Mupirocin and Chlorhexidine to reduce the risk of surgical site infections in orthopaedic surgery: a pre-post study.

BACKGROUND: Nasal carriage of Staphylococcus aureus is a risk factor for surgical site infections (SSI) in orthopaedic surgery. The efficacy of decolonisation for S. aureus on reducing the risk of SSI is uncertain in this speciality. The objective was to evaluate the impact of a nasal screening strategy of S. aureus and targeted decolonisation on the risk of S. aureus SSI. METHODS: A retrospective pre-post and here-elsewhere study was conducted between January 2014 and June 2020 in 2 adult orthopaedic surgical sites (North and South) of a French university hospital. Decolonisation with Mupirocin and Chlorhexidine was conducted in S. aureus carriers starting February 2017 in the South site (intervention group). Scheduled surgical procedures for hip, knee arthroplasties, and osteosyntheses were included and monitored for one year. The rates of S. aureus SSI in the intervention group were compared to a historical control group (South site) and a North control group. The risk factors for S. aureus SSI were analysed by logistic regression. RESULTS: A total of 5,348 surgical procedures was included, 100 SSI of which 30 monomicrobial S. aureus SSI were identified. The preoperative screening result was available for 60% (1,382/2,305) of the intervention group patients. Among these screenings, 25.3% (349/1,382) were positive for S. aureus and the efficacy of the decolonisation was 91.6% (98/107). The rate of S. aureus SSI in the intervention group (0.3%, 7/2,305) was not significantly different from the historical control group (0.5%, 9/1926) but differed significantly from the North control group (1.3%, 14/1,117). After adjustment, the risk factors of S. aureus SSI occurrence were the body mass index (ORaper unit, 1.05; 95%CI, 1.0-1.1), the Charlson comorbidity index (ORaper point, 1.34; 95%CI, 1.0-1.8) and operative time (ORaper minute, 1.01; 95%CI, 1.00-1.02). Having benefited from S. aureus screening/decolonisation was a protective factor (ORa, 0.24; 95%CI, 0.08-0.73). CONCLUSIONS: Despite the low number of SSI, nasal screening and targeted decolonisation of S. aureus were associated with a reduction in S. aureus SSI.

The cultural turn in understanding 'addiction'.

In this essay we want to foreground a question: what happens to 'addiction' when we take seriously cultural scripts informing its trajectories? Can this bring us to unthink addiction as problematic notion and move it onto new paradigms that fit better the now acknowledged fluidity and pluralistic episteme of 'addiction' and more broadly of chronic life conditions? Indeed, 'addiction' has become a pivotal concept in the contemporary world. A powerful diagnostic framework in interpreting human behaviour, for some 'addiction' has become the 'new normal' with chronic relations with different things such as food, sex, gambling, and mind-altering substances touching upon the lifestyle of a majority of individuals, making everyone 'addicts in practice'. Perhaps this has something to do with the constituent force that 'habit' - as in 'addiction' - has in defining our present and future. Though 'addiction' goes beyond the question of mind-altering drugs, the politics of 'addiction' is intimately tied to substances such as opioids and opiates, cocaine, cannabis, and psychedelics that have been the object of durable systemic political control and security repression. Contextually the line between licit/illicit substances is softening and blurring, the 'dual' purpose that drugs serve is now recognised in scientific and popular analysis moving the question of 'addiction' beyond the medicine/drug dichotomy. Yet, culture is generally absent in understanding 'addiction.' When it is referred to, this happens in diminutive terms limited to Anglo-American modern culture. Culture matters and it matters with different weights and measures as it moves across the world. There are cultural environments of health informed by practices and epistemologies of well-being that have evolved in lines opposites from or only intersecting with the Anglo-American, and generally Western, world. Exploring these spaces and cultural scripts enables our scholarship on drugs and 'addiction' to move the barycentre of discussion towards novel considerations around the historical trajectories and potential futures of our diagnostic terms and policy interventions.

"Listen with your ears and eyes and heart and your minds and your soul": Implications for decolonising consultation and occupational therapy from case studies on "Closing the Gap" policy implementation.

BACKGROUND: Including Aboriginal and Torres Strait Islander people and communities through consultation has been a key feature of policy implementation throughout the Australian Government's "Closing the Gap" (CTG) strategy. However, consultation often reinforces power imbalances between government and local community and can undervalue or marginalise Indigenous knowledge and leadership. Occupational therapy has a short history of examining colonial power structures within the profession, but there has been limited progress to decolonise consultation and practice. METHODS: Drawing on decolonising research methodology and positioned at the interface of knowledge, comparative case studies were used to understand policy implementation in two regions. In Shepparton, Victoria, CTG policy was implemented predominately through an Aboriginal Community Controlled Health Organisation, and in Southern Adelaide, South Australia, CTG policy was implemented through mainstream state government and non-government providers in the absence of a local Aboriginal-controlled organisation. Findings were examined critically to identify implications for occupational therapy. RESULTS: Our case studies showed that policy stakeholders perceived consultation to be tokenistic and partnerships were viewed differently by Aboriginal and non-Indigenous participants. Participants identified the need to move beyond a rhetoric of "working with" Aboriginal and Torres Strait Islander people, to promote Aboriginal leadership and really listen to community so that policy can respond to local need. The findings of this research show that Aboriginal-controlled services are best positioned to conduct and respond to community consultation. CONCLUSION: A decolonising approach to consultation would shift the status quo in policy implementation in ways that realign power away from colonial structures towards collaboration with Indigenous leadership and the promotion of Aboriginal-controlled services. There are lessons for occupational therapy from this research on policy implementation on authentic, decolonised consultation as a key feature of policy implementation. Shifting power imbalances through prioritising Indigenous leadership and honouring what is shared can drive change in CTG policy implementation processes and outcomes.

A Critical Understanding of Inclusion in Oral Microbiome Research through the Lens of Racial Capitalism.

There are important calls for greater inclusion of Indigenous and racialised communities in oral microbiome research. This paper uses the concept of racial capitalism (the extractive continuity of colonialism) to critically examine this inclusion agenda. Racial capitalism explicitly links capitalist exploitations with wider social oppressions e.g., racisms, sexism, ableism. It is not confined to the commercial sector but pervades white institutions, including universities. By using the lens of racial capitalism, we find inclusion agendas allow white institutions to extract social and economic value from relations of race. Racially inclusive research is perceived as a social good, therefore, it attracts funding. Knowledge and treatments developed from research create immense value for universities and pharmaceutical companies with limited benefits for the communities themselves. Moreover, microbiome research tends to drift from conceptualisations that recognise it as something that is shaped by the social, including racisms, to one that is determined genetically and biologically. This location of problems within racialised bodies reinforces racial oppressions and allows companies to further profit from raciality. Inclusion in oral microbiome research must consider ways to mitigate racial capitalism. Researchers can be less extractive by using an anti-racism praxis framework. This includes working with communities to co-design studies, create safer spaces, giving marginalised communities the power to set and frame agendas, sharing research knowledges and treatments through accessible knowledge distributions, open publications, and open health technologies. Most importantly, inclusion agendas must not displace ambitions of the deeper anti-oppression social reforms needed to tackle health inequalities and create meaningful inclusion.

Exploring clinical reasoning in child language assessment through decoloniality.

PURPOSE: Clinical reasoning has been taught, practised, and researched under Western epistemologies, which have been fallible in addressing the complexity of clinical reasoning within Indigenous cultures and societies. We explored how speech-language pathologists in Sri Lanka negotiate and value Indigenous and Western perspectives in clinical reasoning within a decolonial framework. METHOD: This study used participatory research methodology within the decolonised qualitative research paradigm to produce data collaboratively with eight Sri Lankan speech-language pathologists. Oral history narratives and object-based textual reflections generated the necessary data for the study. Systematic visual-textual analysis and reflexive thematic analysis were carried out iteratively, and the data analysis and interpretation were undertaken collaboratively with the participants. RESULT: We generated four key themes about professional education, individuality in practice, holistic thinking, and balancing interests and priorities. The results demonstrate that social, political, and economic forces impact practitioners' clinical reasoning. CONCLUSION: Practising science in its original form within Indigenous contexts is challenging. Colonial roots and imperialism impact the delivery of appropriate services in socially and politically marginalised communities. Practitioners' self-awareness about authentic identities and practical wisdom can develop culturally relevant knowledge for equitable practice.

Is qualitative social research in global health fulfilling its potential?: a systematic evidence mapping of research on point-of-care testing in low- and middle-income contexts.

BACKGROUND: Qualitative social research has made valuable contributions to understanding technology-based interventions in global health. However, we have little evidence of who is carrying out this research, where, how, for what purpose, or the overall scope of this body of work. To address these questions, we undertook a systematic evidence mapping of one area of technology-focused research in global health, related to the development, deployment and use of point-of-care tests (POCTs) for low-and middle-income countries (LMICs). METHODS: We conducted an exhaustive search to identify papers reporting on primary qualitative studies that explore the development, deployment, and use of POCTs in LMICs and screened results to identify studies meeting the inclusion criteria. Data were extracted from included studies and descriptive analyses were conducted. RESULTS: One hundred thirty-eight studies met our inclusion criteria, with numbers increasing year by year. Funding of studies was primarily credited to high income country (HIC)-based institutions (95%) and 64% of first authors were affiliated with HIC-based institutions. Study sites, in contrast, were concentrated in a small number of LMICs. Relatively few studies examined social phenomena related to POCTs that take place in HICs. Seventy-one percent of papers reported on studies conducted within the context of a trial or intervention. Eighty percent reported on studies considering POCTs for HIV and/or malaria. Studies overwhelmingly reported on POCT use (91%) within primary-level health facilities (60%) or in hospitals (30%) and explored the perspectives of the health workforce (70%). CONCLUSIONS: A reflexive approach to the role, status, and contribution of qualitative and social science research is crucial to identifying the contributions it can make to the production of global health knowledge and understanding the roles technology can play in achieving global health goals. The body of qualitative social research on POCTs for LMICs is highly concentrated in scope, overwhelmingly focuses on testing in the context of a narrow number of donor-supported initiatives and is driven by HIC resources and expertise. To optimise the full potential of qualitative social research requires the promotion of open and just research ecosystems that broaden the scope of inquiry beyond established public health paradigms and build social science capacity in LMICs.

What we do matters: Supporting anti-racism and decolonisation of public health teaching and practice through the development of Maori public health competencies.

OBJECTIVE: This research sought to expand on a set of core Maori hauora a-iwi/public health competencies initially designed for teaching and to enable their use in workplaces. METHODS: The research used a kaupapa Maori methodology in four stages including the development of draft levels of competence for all core competencies, consultation hui (meetings), analysis of feedback and redrafting, and respondent validation. RESULTS: Key themes elicited in relation to the content of the competencies included increasing language expectations, the importance of strength-based approaches and self-determination, and the need for individual responsibility to address structural racism. Reflective practice was identified as a fundamental cross-cutting competency. Participants suggested planetary health and political ideologies be included as additional socio-political determinants of health with equity impacts. Key concerns related to the application of the competency document included the need for cultural safety and ensuring that all public health practitioners are 'seen'. CONCLUSIONS: The Maori hauora a-iwi/public health competencies have been published under a Creative Commons licence. IMPLICATIONS FOR PUBLIC HEALTH: The process of drafting a set of Maori public health competencies elicited key themes potentially relevant for public health practice in other countries and resulted in a competency document for use by universities and workplaces.

Teaching Scottish medical students about global health in partnership with LMIC institutions. Does it change their views on volunteering in LMIC settings?

CONTEXT: An elective placement is a core part of most United Kingdom (UK) medical degrees, and a significant proportion of students choose to pursue their elective in low- and middle-income countries (LMIC). There is a risk that students are ill-prepared for some of the ethical challenges that they will face during these placements, and that they have little appreciation for some of the negative effects that their placement can have on the host healthcare system. This study sought to address some of these negative consequences by exploring the preparation of medical students for these experiences, and the effect of including the LMIC perspective in preparation materials. METHODS: This qualitative study used thematic analysis to explore the attitudes of final year medical students at a Scottish medical school to international volunteering, after completing a module on global health. This module was designed and delivered in partnership with academics from Malawi, Rwanda and Zambia, thus incorporating a strong LMIC perspective. FINDINGS: This study demonstrated the ability of a global health module with a strong LMIC perspective to influence the attitudes of final year medical students in the following ways: 1) Challenging assumptions around international volunteering and, in particular, around some of the negative effects of international volunteering that had not previously been considered. 2) Changing future practice around international volunteering. IMPLICATIONS: This study provides good evidence that having a strong LMIC voice in preparation materials for medical students embarking on LMIC electives has the ability to increase awareness of some of the potential harms, and to positively influence how they plan to have discussions around and approach such experiences in the future.

Climate change and Indigenous mental health in Australia: In the aftermath of the defeat of the Voice referendum.

INTRODUCTION: This manuscript delves into the intricate connection between climate change and Indigenous mental health in Australia, with a focus on the aftermath of the defeat of the 'Voice' referendum. Climate change, recognized for its broad impact on mental health determinants, poses heightened risks to vulnerable communities, including Indigenous populations. The defeat of 'The Voice' referendum adds complexity, highlighting concerns about the lack of meaningful rights for the First Peoples of Australia. The bushfires further underscore ecological consequences, affecting Indigenous ecosystems and intensifying existing environmental challenges. Climate change exacerbates existing health challenges for Indigenous peoples, introducing new issues like ecological sorrow and anxiety. METHODOLOGY: The manuscript advocates for prioritized research in Indigenous communities to explore the link between climate change and mental health. It emphasizes interdisciplinary and collaborative research, giving voice to those directly affected by climate change. The lack of trust between Indigenous populations and authorities, along with the implications on self-determination, is crucial research focus. RESULTS: Renewable energy emerges as a potential solution deeply ingrained in Indigenous practices. The manuscript discusses challenges in achieving eco-friendly resettlement, emphasizing collaboration difficulties between the government and remote communities. The indigenous worldview, with its interconnectedness, is crucial for sustainable strategies. DISCUSSION AND FUTURE DIRECTIONS: Indigenous perspectives on planetary health are crucial, emphasizing the importance of Indigenous knowledge in shaping effective climate policies. The manuscript stresses dialogues between policymakers and Indigenous elders for formulating respectful land laws. It calls for global attention to the role of Indigenous peoples as biodiversity caretakers and urges recognition of their knowledge in climate change. Future directions include data collection for ecosystem protection, improving mental health outcomes post-climate events, and supporting impacted communities. Mental health care approaches in remote communities and practitioner training for climate-related issues are emphasized. The manuscript calls for increased funding for interdisciplinary research to understand the long-term impact of climate change on mental health, especially among vulnerable populations.

Designing equity, diversity, and inclusion training for postgraduate parasitologists.

Equity, diversity, and inclusion (EDI) have received increased attention in the sciences, with increasing expectation that students will receive formal training in this area. However, compared with other biosciences, little guidance has been produced for parasitology educators. Therefore, this article presents the contents and evaluation of pilot training designed for postgraduates.

Diversifying the dental curriculum: A review of the Bachelor of Dental Surgery degree reading lists in a UK dental school.

INTRODUCTION: Analysis of the diversity of reading lists on courses offered by universities is one way to assess what is being taught and how it shapes our understanding of the world. Very little work has been carried out so far within dentistry on decolonising the curriculum. Existing work looks at the representation of women or ethnic minorities but not at the dental curriculum per se. This article starts to address this. METHODS: The reading lists within the 5 year Bachelor of Dental Surgery curriculum in a large UK dental school were collected and assessed. A data extraction spreadsheet was developed and journal articles on every course reading list across the 5 year curriculum were read in detail. Information on authorship and author affiliations, alongside patient and population representation within the article itself, were collected and collated. RESULTS: We found that there are 2.5 times more male authors than female authors, and almost three times more male lead authors in the articles evaluated. The majority of journal articles included in the reading lists are written by academics and/or clinicians affiliated with institutions in the United Kingdom and most articles are from the global north. In addition, 65% of articles do not specify the focus patient or population group studied. DISCUSSION: It is unlikely that current reading lists within dentistry fully reflect the composition of the profession itself, the variety of knowledge needed to provide evidence-based practice in a globalised oral health arena or the heterogeneous nature of the patient population.

Occupation in the Anthropocene and Ethical Relationality.

Purpose. Occupations have "implications for individuals, societies, and the earth". This article focusses on implications of occupation in relation to the earth and examines the potential to expand occupational justice beyond anthropocentric viewpoints to honour interspecies justice. Approach. A 'theory as method' approach is used to explore the literature. Transgressive decolonial hermeneutics informs analysis. Key issues. The discussion advances understandings about human occupation in relation to more-than-humans, intersections with human occupations and animals, and ethical relationality. Implications. Occupational justice includes honouring interdependence of species, engaging in occupations in ways that are sustainable, considering future generations, and refraining from occupations that have a destructive or detrimental impact on the earth and more-than-humans. The profession has a collective responsibility to honour Indigenous worldviews and Indigenous sovereignty, recognising and welcoming the potential for Western conceptualisations of occupation to be transformed.

Why and how is photovoice used as a decolonising method for health research with Indigenous communities in the United States and Canada? A scoping review.

Globally, including in North America, Indigenous populations have poorer health than non-Indigenous populations. This health disparity results from inequality and marginalisation associated with colonialism. Photovoice is a community-based participatory research method that amplifies the voices of research participants. Why and how photovoice has been used as a decolonising method for addressing Indigenous health inequalities has not been mapped. A scoping review of the literature on photovoice for Indigenous health research in the United States and Canada was carried out. Five electronic databases and the grey literature were searched, with no time limit. A total of 215 titles and abstracts and 97 full texts were screened resulting in 57 included articles. Analysis incorporated Lalita Bharadwaj's Framework For Building Research Partnerships with First Nations Communities. Photovoice was selected to improve knowledge mobilisation and participant empowerment and engagement. Studies incorporated relationship building, meaningful data collection, and public dissemination but had a lesser focus on the inclusion of Indigenous peer researchers or participant involvement in analysis. For photovoice to truly realise its decolonising potential, it must be incorporated into a broader participatory and decolonising research paradigm. In addition, more resources are required to support the involvement of Indigenous people in the research process.

Thinking with Civets: The Role of Zoos in the Decolonisation of Animal Tourism.

Civets belong to the family Viverridae, an ancient line of 'cat-like' animals. Despite their large geographic distribution across southeast Asia and parts of Africa, little scientific attention has been attributed to Viverrids or Viverrid-human relations. This paper applies the lens of civets to explore the tensive intersection between animal welfare, conservation, and colonialism within the tourism landscape. Through thinking with civets, this paper brings two forms of animal commodification into dialogue: (1) the management of civets in zoos around the globe and (2) the rising trend in civet coffee production and tourism in Asia. By qualitatively analysing the entanglements between colonialism, animal welfare, and conservation and how each impacts the lives and treatment of civets in tourism, this paper calls for enhanced reflexivity and thus the decolonisation of animal-based tourism. Suggestions are made on how zoos may progress towards the decolonisation of animal tourism, and the argument is made that zoos are well positioned and morally obligated to answer this call. By doing so, greater attention can be given to the animals whose lives are most affected by the global tourism landscape.

Decolonising global mental health: The role of Mad Studies.

In recent years, there has been a growing and high-profile movement for 'global mental health'. This has been framed in 'psych system' terms and had a particular focus on what has come to be called the 'Global South' or 'low and middle-income countries'. However, an emerging 'Mad Studies' new social movement has also developed as a key challenge to such globalising pressures. This development, however, has itself both being impeded by some of the disempowering foundations of a global mental health approach, as well as coming in for criticism for itself perpetuating some of the same problems as the latter. At the same time, we are also beginning to see it and related concepts like the UNCRPD being given new life and meaning by Global South activists as well as Global North activists. Given such contradictions and complexities, the aim of this paper is to offer an analysis and explore ways forward consistent with decolonizing global mental health and addressing madness and distress more helpfully globally, through a Mad Studies lens.

Racialised capitalism, decoloniality and the university: an exploration of the colour line and colonial unreason in higher education.

Over the last decade, there has been an increase in calls to address important questions on race and decolonisation within the university, administratively, pedagogically, and socially. This study investigates the relationship between the university, the coloniser, and the colonised during the colonial era and the afterlife. It aims to demonstrate that the university has made the act of abstraction and theorisation central across disciplines in a way that shears theoretical principles from the historical contexts they emerge from, distancing them from the purposes, people, and interests they were meant to serve, as well as the populations they were meant to dispossess and disempower. The study provides a conceptual framework for deconstructive analysis of the university's pedagogical operations and societal function with the view to elucidate the university's colonial and racial blind spots, notably, with a reliance on disciplinary narratives from development, international relations, and international law to offer tentative answers to the questions of decolonial praxis, the decolonial scholar, and coloniality in the contemporary university.

'They Just Let Us Rot to Death:' Anti-Colonialism, Contestation, and Resistance to Reparations for Indian Residential School Abuse.

In the wake of increasing attention to reparations for settler colonialism in recent years, the politics of refusal and contestation of reparations has remained an underexplored area in socio-legal research. This article addresses this gap by foregrounding the perspectives of the colonised as a focal point to examine the strategies they mobilise to stage resistance to state-sponsored redress and to expose the harmful logics and legacies of ongoing settler colonialism. Strategies of resistance are discussed in the context of the Independent Assessment Process - a financial compensation process designed to provide redress to survivors of the physical and sexual violence they had suffered while attending Canada's Indian Residential Schools. This article explores how survivors disrupted the compensation process to advance an anti-colonial agenda, to politicise the violence, and to compel the settler state to recognise their lived experiences and realities of structural violence in the settler colonial present.

Confronting Colonialism in Canadian Dietetics Curricula.

Many Canadian universities have committed to becoming more accountable to Indigenous Peoples by confronting the systemic, historical, and ongoing colonialism and anti-Indigenous racism that shape their campuses. In this Perspective in Practice piece, we invite the field of dietetics to consider how colonialism has shaped dietetics research, teaching, and practice. We also consider how we might transform the field of dietetics in ways that accept settler responsibility for interrupting racism and colonial harm; support the resurgence of Indigenous food and health practices; and recognise the connections between struggles to ensure that Indigenous Peoples can access culturally appropriate food and health care, and struggles for Indigenous sovereignty and self-determination. We do this by reviewing the history of the dietetics field, examining critical responses to existing Indigenisation and decolonisation efforts, and reflecting on recent changes to required dietetics competencies. We argue that curricula in dietetics programmes must teach the history of the colonial food system and equip students to identify and interrupt the individual and institutional colonial dynamics that contribute to the ongoing dispossession of Indigenous Peoples' lands and food sources and negatively impact Indigenous patients.

Grandmother-inclusive intergenerational approaches: the missing piece of the puzzle for ending FGM/C by 2030?

This brief argues that "grandmother-exclusionary bias" - or the side-lining of female elders as change agents within FGM/C programmes - represents a major obstacle to eradication of these practices. Grandmother-exclusionary bias is prevalent within FGM/C policy and programming. Yet, it goes against evidence of the extensive authority and decision-making roles that grandmothers wield in relation to FGM/C in sub-Saharan Africa, and insights from systems theory and meta-evaluations of FGM/C eradication efforts which stress that sustained change requires engaging those who wield authority over gender and social norms. We use postcolonial and decolonial theory to explain the assumptions about grandmothers which underpin grandmother-exclusionary bias. Finally, we provide recommendations for designing grandmother-inclusive, intergenerational community-led programmes based on a strategy empirically proven to shift social norms underpinning FGM/C.

Realising distributed leadership through measurement for change.

Through a systematic reflection on the journey that transformed traditional state-run baby homes in Tajikistan from closed institutions into community-oriented Family and Child Support Centres (FCSC) we reveal key moments of change. This review describes how community consultation with local participants in a development project shifted responsibility and accountability from international to local ownership and how distributed leadership contributes to the decolonisation of social services. Based on these interviews we ask, 'How do the innovations of a social development project become a fixed part of normal local social, cultural and political life; and, how do we know when a new normal is self-sustaining at a local level?' This analysis builds on a network-mapping tool previously described in this journal. Our interviews show that each participant has taken a non-linear journey, building on the networks previously described, under the influence of activities and discussions that emerged throughout the project. We consider how a monitoring, evaluation, and learning process should be responsive over time to these influences, rather than be set at the start of the project. Using the themes that emerge from participants' journeys, we apply a 'measurement for change' (M4C) approach that integrates Monitoring, Evaluation and Learning (MEL) into decision-making. The journey framework applied represents a systematic application of the M4C approach that gives us insight into where local ownership is responsible for the sustainable management of the intervention, and where continued partnership will further strengthen impact and accountability. The exercise has provided evidence of progress towards decolonisation and of the centring of local priorities in MEL and implementation processes.