Stigmatised Identity and Service Usage in Disadvantaged Communities: Residents’, community workers’ and service providers’ perspectives.

The impact of community stigmatisation upon service usage has been largely overlooked from a social identity perspective. Specifically, the social identity-mediated mechanisms by which stigmatisation hinders service use remain unspecified. The present study examines how service providers, community workers and residents recount their experience of the stigmatisation of local community identity and how this shapes residents’ uptake of welfare, education and community support services. Twenty individual and group interviews with 10 residents, 16 community workers and six statutory service providers in economically disadvantaged communities in Limerick, Ireland, were thematically analysed.Analysis indicates that statutory service providers endorsed negative stereotypes of disadvantaged areas as separate and anti-social. The awareness of this perceived division and the experience of ‘stigma consciousness’ was reported by residents and community workers to undermine trust, leading to under-utilisation of community and government services. We argue that stigmatisation acts as a ‘social curse’ by undermining shared identity between service users and providers and so turning a potentially cooperative intragroup relationship into a fraught intergroup one. We suggest that tackling stigma in order to foster a sense of shared identity is important in creating positive and cooperative service interactions for both service users and providers.

Receptor-mediated endocytosis and intracellular trafficking of insulin and low-density lipoprotein by retinal vascular endothelial cells

PURPOSE: The authors investigated the receptor-mediated endocytosis (RME) and intracellular trafficking of insulin and low-density lipoprotein (LDL) in cultured retinal vascular endothelial cells (RVECs). METHODS: Low-density lipoprotein and insulin were conjugated to 10 nm colloidal gold, and these ligands were added to cultured bovine RVECs for 20 minutes at 4 degrees C. The cultures were then warmed to 37 degrees C and fixed after incubation times between 30 seconds and 1 hour. Control cells were incubated with unconjugated gold colloid at times and concentrations similar to those of the ligands. Additional control cells were exposed to several concentrations of anti-insulin receptor antibody or a saturating solution of unconjugated insulin before incubation with gold insulin. RESULTS: Using transmission electron microscopy, insulin gold and LDL gold were both observed at various stages of RME. Insulin-gold particles were first seen to bind to the apical plasma membrane (PM) before clustering in clathrin-coated pits and internalization in coated vesicles. Gold was later visualized in uncoated cytoplasmic vesicles, corresponding to early endosomes and multivesicular bodies (MVBs) or late endosomes. In several instances, localized regions of the limiting membrane of the MVBs appeared coated, a feature of endosomal membranes not previously described. After RME at the apical PM and passage through the endosomal system, the greater part of both insulin- and LDL-gold conjugates was seen to accumulate in large lysosome-like compartments. However, a small but significant proportion of the internalized ligands was transcytosed and released as discrete membrane-associated quanta at the basal cell surface. The uptake of LDL gold was greatly increased in highly vacuolated, late-passage RVECs. In controls, anti-insulin receptor antibody and excess unconjugated insulin caused up to 89% inhibition in gold-insulin binding and internalization. CONCLUSION: These results illustrate the internalization and intracellular trafficking by RVECs of insulin and LDL through highly efficient RME, and they provide evidence for at least two possible fates for the endocytosed ligands. This study outlines a route by which vital macromolecules may cross the inner blood-retinal barrier.

Donegall Pass: Towards a sustainable community:Chapter 5, Health and Wellbeing

Key Points

International research has long since established a gradient between health and socio-economic status and it is now clear that the social and physical context in which people live can have a negative influence on health.

Recent research has established an adverse effect on the health of people who remained in an area that had become more deprived over time

The mechanisms thought to influence health in declining communities include stress, loss of self-esteem, stigma, powerlessness, a lack of hope and fatalism.

These mechanisms are related to the concept of social capital, a resource produced when people co-operate for mutual benefit

Residents’ key concerns relating to the decline in the community are housing shortages which are perceived to be contributing to the breakdown of the family-based community, along with traffic; pollution; non-resident parking problems; a lack of youth facilities; and the influx of ethnic minorities who are less inclined to become involved with the community

In the Donegall Pass a dual process of outward migration and business development has resulted in a decline in social capital within the community which was particularly evident amongst the younger generations

People living in deprived areas, such as the Donegall Pass, that are adjacent to affluent areas, such as the new apartment developments surrounding the area, can often feel relatively more deprived due to such direct comparisons. Although relative deprivation was evident, peer comparisons with the Donegal Road/Sandy Row community were more commonly expressed

The area can be described as a ‘food desert’ as no affordable fresh grocery supplies are available within walking distance

Residents expressed mixed opinions about the future of the Donegall Pass including a common sense of resignation towards the decline in the core community

Many residents recognise the need for people to work together and gain empowerment in order to work with the authorities (i.e., the Housing Executive and the Council) towards progressive re-development that is in keeping with the aims of the community members, however, equally many were impervious towards these suggestions feeling that previous efforts had gone unrewarded.

Creating an eLearning Resource to Improve Knowledge and Understanding of Pregnancy in the Context of HIV Infection

Patient narratives have much to teach healthcare professionals about the experience of living with a chronic condition. While the biomedical narrative of HIV treatment is hugely encouraging, the narrative of living with HIV continues to be overshadowed by a persuasive perception of stigma. This paper presents how we sought to translate the evidence from a qualitative study of the perspectives of HIV affected pregnant women and expectant fathers on the care they received, from the pre conception to post natal period, into educational material for maternity care practice. Narrative scripts were written based on the original research interviews, with care taken to reflect the key themes from the research. We explore the way in which the qualitative findings bring to life patient and partner experiences and what it means for nurses, midwives and doctors to be prepared to care for couples affected by HIV. In so doing, we challenge the inequity between the dominance of biomedical knowledge over understanding the patient experience in the preparation of health professionals to care for HIV affected women and men who are having a baby or seeking to have a baby.

Disordered Eating in first year university students: A qualitative study exploring student and support service needs

The paper reports on a qualitative study exploring disordered eating in younger first-year students studying for professional health care related degrees (n=12), and highlights a number of support mechanisms and services required for those students at risk.

Key issues emerging in relation to disordered eating included: concealment; lack of understanding to the nature/risks associated; its use as a stress coping mechanism; isolation; perception as mental health issues with attaching stigma and reticence to acknowledge; invisible experience; wariness of eating in more public refectories. Finally positivity about their arrival at university and that their experience with disordered eating could potentially add to their repertoire as future health care professionals.

Conclusion: The University could; further develop its outreach to new students with a more consistently supportive person-centred program including stress training and more support via student buddying; extend its program on positive mental health; greater awareness particularly the sub-clinical group; consider some small changes and adaptations to the refectory eating areas to better facilitate at- risk students. Finally the University could perhaps better use the first few months of student's arrival at university to help embed a program to develop a stronger sense of coherence and well-being.

'Every pregnant woman needs a midwife'--the experiences of HIV affected women in maternity care

TITLE: 'Every pregnant woman needs a midwife'-the experiences of HIV affected women in Northern Ireland.

OBJECTIVE: to explore HIV positive women's experiences of pregnancy and maternity care, with a focus on their interactions with midwives.

DESIGN: a prospective qualitative study.

SETTING: regional HIV unit in Northern Ireland.

PARTICIPANTS: 22 interviews were conducted with 10 women at different stages of their reproductive trajectories.

FINDINGS: the pervasive presence of HIV related stigma threatened the women's experience of pregnancy and care. The key staff attributes that facilitated a positive experience were knowledge and experience, empathy and understanding of their unique needs and continuity of care.

KEY CONCLUSIONS: pregnancy in the context of HIV, whilst offering a much needed sense of normality, also increases woman's sense of anxiety and vulnerability and therefore the need for supportive interventions that affirm normality is intensified. A maternity team approach, with a focus on providing 'balanced care' could meet all of the woman and child's medical needs, whilst also emphasising the normalcy of pregnancy.

Knowledge translation in men’s health research: development and delivery of content for use online

Background: Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men’s health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation.
Objective: Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men’s health.

Methods: We present experiences of KT across two case studies of men’s health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men’s depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men’s depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled “If I Were Jack”.

Results: For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men’s health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset.

Conclusions: The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work.

A study exploring disordered eating patterns in first-year university students: student and service needs

This qualitative study explored disordered eating in a small group of first-year undergraduate students and addresses a gap in the literature by exploring their lived experience.

Aims: To better understand student’s needs in those experiencing or at risk of developing disordered eating during their first year at university and to illustrate what support mechanisms and services are required to better support students experiencing or at risk during their first year at university.

Conclusion: The University could further develop its outreach to new students with a more consistently supportive programme providing better facilities and training for stress appraisal and coping and more support via student buddying. The University could also extend its programme on positive mental health in an attempt to better inform on disordered eating and to reduce a sense of stigma within the student population. Personal tutors and student health care facilities need to be consistently trained in the understanding and person centred approach to students experiencing disordered eating, particularly the sub-clinical group. In addition the University could consider some small changes and adaptations to the refectory eating areas to better facilitate students who may be at risk from disordered eating. Finally the University could perhaps better use the potentially liminal period within the first few months of student's arrival at university (a new beginning) to help embed a program to develop a stronger sense of coherence and well-being.

Risk, Recovery and Capacity: Competing or Complementary Approaches to Mental Health Social Work

Mental health social workers have a central role in providing support to people with mental health problems and in the use of coercion aimed at dealing with risk. Mental health services have traditionally focused on monitoring symptoms and ascertaining the risks people may present to themselves and/or others. This well-intentioned but negative focus on deficits has contributed to stigma, discrimination and exclusion experienced by service users. Emerging understandings of risk also suggest that our inability to accurately predict the future makes risk a problematic foundation for compulsory intervention. It is therefore argued that alternative approaches are needed to make issues of power and inequality transparent. This article focuses on two areas of practice: the use of recovery based approaches, which promote supported decision making and inclusion; and the assessment of a person’s ability to make decisions, their mental capacity, as a less discriminatory gateway criterion than risk for compulsory intervention.

Endosomal signaling and oncogenesis

The endosomal system provides a route whereby nutrients, viruses, and receptors are internalized. During the course of endocytosis, activated receptors can accumulate within endosomal structures and certain signal-transducing molecules can be recruited to endosomal membranes. In the context of signaling and cancer, they provide platforms within the cell from which signals can be potentiated or attenuated. Regulation of the duration of receptor signaling is a pivotal means of refining growth responses in cells. In cancers, this is often considered in terms of mutations that affect receptor tyrosine kinases and maintain them in hyperactivated states of dimerization and/or phosphorylation. However, disruption to the regulatory control exerted by the assembly of protein complexes within the endosomal network can also contribute to disease among which oncogenesis is characterized in part by dysregulated growth, enhanced cell survival, and changes in the expression of markers of differentiation. In this chapter, we will discuss the role of proteins that regulate in endocytosis as tumor suppressors or oncogenes and how changing the fate of internalized receptors and concomitant endosomal signaling can contribute to cancer.

Clathrin adaptor epsinR is required for retrograde sorting on early endosomal membranes

Retrograde transport links early/recycling endosomes to the trans-Golgi network (TGN), thereby connecting the endocytic and the biosynthetic/secretory pathways. To determine how internalized molecules are targeted to the retrograde route, we have interfered with the function of clathrin and that of two proteins that interact with it, AP1 and epsinR. We found that the glycosphingolipid binding bacterial Shiga toxin entered cells efficiently when clathrin expression was inhibited. However, retrograde transport of Shiga toxin to the TGN was strongly inhibited. This allowed us to show that for Shiga toxin, retrograde sorting on early/recycling endosomes depends on clathrin and epsinR, but not AP1. EpsinR was also involved in retrograde transport of two endogenous proteins, TGN38/46 and mannose 6-phosphate receptor. In conclusion, our work reveals the existence of clathrin-independent and -dependent transport steps in the retrograde route, and establishes a function for clathrin and epsinR at the endosome-TGN interface.

Suicide and parasuicide: a selected review of the literature.

The increase in adolescent suicides has prompted the World Health Organization to set targets to reduce the incidence of deaths by the year 2000. In order to achieve this target further investigation into the perceptions of adolescent parasuicidal individuals is required to reduce the number of suicide attempts. Statistical evidence shows that parasuicidal individuals are commonly females who attempt suicide by taking an overdose. In the majority of cases help has been sought within the month prior to the attempt. Following an attempt many individuals feel isolated or ignored by health professionals. It appears that communication difficulties and negative attitudes by health professionals often reinforce the stigma associated with suicide. Nurses can contribute to the prevention of parasuicide/suicide by actively providing therapeutic care and counselling parasuicidal individuals to help them deal with major life events.

Seeking help from everyone and no-one: Conceptualising the online help-seeking process among adolescent males

Online help-seeking is an emerging trend within the 21st century. Yet despite some movement towards developing online services, little is known about how young people locate, access and receive support online. This study aims to conceptualise the process of online help-seeking among adolescent males. Modified photo-elicitation techniques were employed within eight semi-structured focus group sessions with adolescent males aged 14 – 15 years (n= 56) across seven schools in Northern Ireland. Thematic analyses was conducted within an ontological framework of critical realism and an epistemological framework of contextualism. Informal online help-seeking pathways increased opportunity for social support and reduced stigma but also included loss of control and reduced anonymity. Formal pathways offered increased anonymity but concerns were raised regarding participants’ ability to locate and appraise the quality of information online. A conceptual model of online help-seeking has been developed to highlight the key help seeking pathways taken by adolescent males.

A Agenda 21 local e o desenvolvimento sustentável em Portugal : que perspetivas?

Assumindo a sociedade atual o paradigma do desenvolvimento sustentável como modelo capaz de garantir uma gestão equilibrada dos recursos atuais que não comprometa o futuro das futuras gerações, é fundamental compreender o instrumento da Agenda 21 Local (A21L), ferramenta saída da Conferência do Rio, em 1992, que se apresenta como uma resposta internacional aos objetivos da sustentabilidade. Ao constituir-se como país signatário da Declaração do Rio, Portugal assumiu o compromisso de cooperar internacionalmente para a aplicação deste instrumento, no esforço comum de unir a proteção do ambiente com o desenvolvimento económico e social. Verifica-se que a resposta de Portugal, em matéria de A21L, foi pouco conseguida, marcada por um arranque ténue, desconcertado e disperso a que acresce o caráter dúbio que caracterizou a natureza dos primeiros processos e que, no quadro internacional, atira Portugal para o grupo de países europeus que mais tardiamente conseguiram responder ao apelo da comunidade internacional no que se refere à implementação de A21L. Neste âmbito, esta dissertação visa aprofundar o conhecimento cientifico sobre este instrumento no quadro das experiências de Agenda 21 Local implementadas no território português. O trabalho procurou examinar os objetivos, características e resultados dos processos de Agenda, dando atenção aos elementos individuais que marcaram cada um e, igualmente, avaliando as repercussões que estes tiveram no todo nacional. O estudo incidiu na dinâmica espaciotemporal das Agendas21L, no território nacional, e na análise integrativa de indicadores físicos, sociais e económicos que permitiram compreender as especificidades e os contrastes verificados nos processos implementados e desenvolvidos. Na investigação não foram, igualmente, negligenciadas questões históricas, políticas e culturais, sabendose da importância que estes vários domínios configuram no caso português. O trabalho contou com uma investigação assente na seguinte metodologia: i) Revisão da literatura e recolha de dados bibliográficos sobre a temática da Agenda 21 Local; ii) Levantamento de informação, através de um inquérito por questionário, dirigido a todas as localidades do País, onde decorrem Agendas 21 Local, a fim de complementar informação já processada; iii) Pesquisa direta de dados no terreno que envolveu a utilização de procedimentos de teor quantitativo (inquérito por questionário) e de teor qualitativo (entrevistas), relativamente ao caso de estudo (Agenda 21 Local de Mindelo); iv) Tratamento e análise dos resultados obtidos através da confrontação da perspetiva teórica com a prática com a consequente elaboração de conclusões fundamentadas pela confrontação dos dados com as hipóteses. Para além de se tratar do caso pioneiro de A21L com início no poder mais próximo do cidadão (respeitando um dos princípios inerentes a este instrumento – o princípio da subsidiariedade), afirmou-se, igualmente, como um caso de referência em matéria de coesão e mobilização dos cidadãos locais para os problemas locais existentes. Os resultados empíricos da investigação identificam uma série de dificuldades que condicionaram o arranque e progresso das A21L. Desde logo, a inabilidade dos poderes políticos locais em trabalharem com um modelo que rompe com as típicas e tradicionais formas pré-concebidas de fazer política, isto é, com as práticas instituídas dos políticos fazerem “política” para os cidadãos e não “com” os cidadãos. O próprio desconhecimento do poder político local quanto à natureza de um processo de A21L que evidenciou inaptidão, impreparação e até embaraço para lidar com este instrumento, resultando na necessidade, na grande maioria dos processos desenvolvidos, de serem acompanhados por entidades externas que cooperaram na sua dinamização. Acresce que a nova dinâmica, subjacente à A21L, que desafia os governos locais a mobilizar a participação generalizada dos cidadãos e apela à participação de novos atores (associações, grupos de interesse, ONG e atores sociais, em geral) para a definição de estratégias de desenvolvimento local, não é totalmente aceite pelos vários poderes locais que, não raras vezes, menosprezam a importância dos cidadãos nos momentos de tomada de decisão. A falta de empenho do governo central, em matéria de sustentabilidade, que negligenciou, numa primeira etapa, a figura do poder central na assessoria às entidades locais cerceou o país da existência de uma campanha nacional para a afirmação deste instrumento. A falta/insuficiência de recursos financeiros como resultante da ausência de apoios estatais e a dificuldade na obtenção de fundos da União Europeia configurou-se como um entrave à promoção dos processos ficando as entidades locais e regionais incapazes de ultrapassar a falta de meios imprescindíveis para o desenvolvimento da A21L. O próprio desconhecimento generalizado dos cidadãos sobre a A21L afigura-se como um estigma ao sucesso de qualquer processo com as caraterísticas de um instrumento A21L visto que a participação dos cidadãos é condição sine qua non para a sua operacionalização. Neste quadro, e olhando o futuro, urge a necessidade das autoridades locais criarem modelos de autofinanciamento capazes de garantir a criação, funcionamento e manutenção de infraestruturas económicas e sociais subjacentes aos programas de A21L, assim como o dever do poder político em reforçar a importância da função da informação e da mobilização dos cidadãos em prole do desenvolvimento sustentável, ações indispensáveis para a execução das políticas inerentes à A21L.

Saber escutar, saber incluir o cidadão com deficiência: uma investigação participativa

O presente trabalho consiste no relatório final de investigação participativa que desenvolvemos tendo como ponto de partida uma preocupação que vivenciamos diariamente, ou seja, a exploração do preconceito diretamente relacionado com as pessoas com deficiência. Sustentado na revisão bibliográfica, o primeiro capítulo focar-se-á na construção social da deficiência e do estigma, mostrando ainda a evolução do modelo de eliminação para o modelo de inclusão da deficiência. Analisa-se, ainda, a importância da escola inclusiva. Tendo como contexto uma IPSS onde trabalhamos, este projeto envolveu quatro participantes que frequentam cursos profissionais e são portadoras de deficiência. Utilizando a investigação-participativa como metodologia, a entrevista e as conversas informais como técnicas de investigação, procurámos construir conhecimento sobre a mudança da realidade através de um processo de reflexão das participantes sobre as suas próprias vidas, a expressão das suas necessidades com o intuito de gerar e reconhecer forças no coletivo e de explorar novos caminhos para a mudança no estatuto social destas mulheres. De todo este processo será dado conta no trabalho que aqui se apresenta.