Background: Indoor and outdoor exposures to fine particulate matter (PM2.5) are both leading risk... more Background: Indoor and outdoor exposures to fine particulate matter (PM2.5) are both leading risk factors for death and disease, but collecting indoor measurements is often infeasible for large stu...
Refugee newcomers almost invariably face "food" culture shock and are at greater risk of food ins... more Refugee newcomers almost invariably face "food" culture shock and are at greater risk of food insecurity due to slow-to-evolve institutions. Community programs can help boost refugee newcomer con dence through knowledge exchange during intercultural culinary experiences. The originally proposed program was "Breaking Down the Walls (BDTW)-Building Integration and Cultural Appreciation through Shared Food Experiences with Refugee Newcomers". With the restrictions set in place due to the COVID-19 pandemic, adaptations were made to the BDTW program. Speci cally, the program's scope was greatly reduced and the program itself shifted to a virtual environment. The nal deliverables for this program included: 1) a framework/guide for conducting intercultural cooking events; and 2) an Online cultural brokerage training tool to help users to grasp some of the food-related challenges faced by newcomers to Canada. To best identify the challenges, successes, and e cacy of conducting community-based research, the team adopted a Developmental Evaluation approach, which is often used in complex settings and evolving scenarios such as the COVID-19 pandemic. The themes which emerged from interviews with participants were further distilled into broader areas of the COVID-19 pandemic, collaboration, and equity. Programs like BDTW have the potential to create infrastructure for newcomer nutrition programming that is integrated and streamlined as a long-term intervention. This type of programming would help shift care practices from sporadically addressing health/nutrition and settlement issues as they arise to a system that proactively anticipates nutritional needs from day one, ultimately promoting long-term health and mental wellbeing among newcomer populations.
Introduction: South Asian communities comprise one of the fastest-growing populations in Canada, ... more Introduction: South Asian communities comprise one of the fastest-growing populations in Canada, but there is a paucity of research on if and how immigrant men use sexual health services. Objectives: Our study aimed to understand factors influencing sexual health service use by South Asian immigrant men living in Ontario, Canada. Methods: An interpretive description (ID) research methodology was used, followed by Braun and Clarke’s thematic guidelines to collect and analyze data. Altogether, 18 semi-structured interviews were conducted between May and July 2021 with South Asian immigrant men between 20 and 45 years of age in Ontario. Results: We found that culture shaped the overall perception and use of sexual health services, while the perceived severity of sexual illness also affected the utilization of preventative care. Moreover, there are taboos about sexual health, and while sex positivity and sex negativity exist, sexual health information is shared with trusted sources. We ...
PurposePatient experience (PE) evaluation can identify critical issues in healthcare quality. Var... more PurposePatient experience (PE) evaluation can identify critical issues in healthcare quality. Various methods are used for PE evaluation in the healthcare system in Ontario; however, evidence suggests that PE evaluation is not systematically performed and has not received substantial buy-in from healthcare providers. This study explores the perspectives of healthcare providers, managers and policymakers in Ontario on PE evaluation methods, barriers, utility and reliability.Design/methodology/approachThe study used a qualitative descriptive design. Twenty-one semistructured interviews were conducted with healthcare providers, managers and policymakers in Ontario between April 2018 and May 2019. The authors used thematic analysis to analyze the data. The Consolidated Criteria for Reporting Qualitative Research quality criteria were used.FindingsBarriers to PE evaluation include evaluation cost and the time and effort required to collect and analyze the data. Several factors affect the...
PurposeSocial media has made a revolutionary change in the relationship between the customers and... more PurposeSocial media has made a revolutionary change in the relationship between the customers and business or service providers by enabling customers to publish and share feedback and views about product or service quality. This revolutionary change has not been echoed in some healthcare systems. This study analyses the social media policies of healthcare regulatory authorities in Ontario and explores how these policies encourage or discourage healthcare professionals' use of social media for collecting patient stories and understanding patient experience.Design/methodology/approachThe study used qualitative content analysis to analyse the policy documents, focusing on the manifest themes in these documents. It used convenient sampling to select 12 organizations, including regulating and licensing bodies and health service delivery organizations in Ontario. The authors collected 24 documents from these organizations, including policies, practice standards and social media learni...
Globally it is recognised that climate change impact is manifested through severe weather events ... more Globally it is recognised that climate change impact is manifested through severe weather events that cause, for example, flooding. Floods have large social consequences for communities and individuals. This paper investigates the impact of flooding on water supply and sanitation conditions together with flood-induced health problems on the Barotse floodplain in Zambia. The study also explored rural response measures and adaptation strategies. This study relied on intensive field investigation in May 2021 where 99 households from different villages in the floodplain were randomly sampled to participate in a questionnaire survey. Key informants, including government officials from the Ministries of Health, Agriculture, and Local Government and Housing, were also interviewed. The findings showed that water supply and sanitation conditions are severely interrupted during flood periods, and this leads to various waterborne diseases. The findings further revealed that all pit latrines in...
The International Journal of Health Planning and Management, 2021
There has been a growing use of social media by patients to share their healthcare experiences an... more There has been a growing use of social media by patients to share their healthcare experiences and produce information that can be helpful to other patients seeking healthcare services. These stories can reveal issues in healthcare quality. However, faced with the inherent risks of social media, healthcare providers have been skeptical about the value of these stories, and many healthcare systems have adopted restrictive and protective policies to control the use of social media by healthcare providers. This study explores healthcare providers' and administrators' perspectives on patient stories on social media and whether they can use the stories to evaluate healthcare experiences. Semi-structured interviews (n = 21) were conducted with healthcare providers and administrators, including physicians, nurses, and quality managers in Ontario, Canada, between April 2018 and May 2019. Inductive and data-driven thematic analysis was used to analyze the data. Several barriers prevent healthcare providers from realizing the benefits of social media, including concerns about the quality of patients' feedback, the professional codes of conduct, and the time and effort required to process these stories. The study findings suggest that cultural changes in the healthcare system might be required to foster the use of social media for healthcare quality improvement and enable the development of a safe patient-provider communication environment that facilitates the exchange of constructive feedback between the two parties without the fear of legal consequences, breaches of patient privacy, or violation of professional codes of conduct.
NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 2021
Scholarship on the health impacts of resource extraction displays prominent gaps and apparent cor... more Scholarship on the health impacts of resource extraction displays prominent gaps and apparent corporate and neocolonial footprints that raise questions about how science is produced. We analyze production of knowledge, on the health impacts of mining, carried out in relation to the Canadian International Resources and Development Institute (CIRDI), a university-based organization with substantial extractive industry involvement and links to Canada’s mining-dominated foreign policy. We use a “political ecology of knowledge” framework to situate CIRDI in the context of neoliberal capitalism, neocolonial sustainable development discourses, and mining industry corporate social responsibility techniques. We then document the interactions of specific health disciplinary conventions and knowledges within CIRDI-related research and advocacy efforts involving a major Canadian global health organization. This analysis illustrates both accommodation and resistance to large-scale political econ...
While most performance judgements are value-relative, in health systems reform it is important to... more While most performance judgements are value-relative, in health systems reform it is important to focus on intermediate performance measures like healthcare access, quality of care and efficiency in healthcare on health status of population, the satisfaction of patients, and the degree to which services are made equitable. However, to date these concepts are not well-defined, remain fairly ambiguous and, consequently, are also not well-measured. Therefore, such concepts do not provide sufficient information to inform changes to the health system that may improve population level outcomes related to structural factors. Our paper established an argument and from our viewpoints we provide a more conceptual clarification on how these three intermediate variables may shape assessments in health system performance, while drawing from the Canadian healthcare system performance gaps and placing them as evidence. We found an immediate need for patient-centred outcome measures in service and ...
The International Journal of Health Planning and Management, 2021
BackgroundPatient experience has a direct impact on patients' engagement in healthcare, their... more BackgroundPatient experience has a direct impact on patients' engagement in healthcare, their commitment to treatment plans, and their relationship with their healthcare providers, all of which can impact their health outcomes. The complexity of the healthcare system, the increasing health needs of the population, and the priority and knowledge differences among healthcare stakeholders impact how they conceptualize and seek to achieve the ideal patient experience and the weights that they give to different elements of this experience.AimsThis study sought to understand the perspectives of healthcare providers and administrators in Ontario regarding the factors affecting the patient experience.Materials & MethodsQualitative data were collected between April 2018 and May 2019. Twenty‐one semi‐structured interviews were conducted. Interviewees included physicians, nurses, optometrists, dietitians, quality managers, and policymakers. Thematic analysis was used to analyse the data, u...
This article outlines an agenda for political science engagement with global mental health. Other... more This article outlines an agenda for political science engagement with global mental health. Other social sciences have tackled the topic, investigating such questions as the link between poverty and mental health disorders. Political science is noticeably absent from these explorations. This is striking because mental health disorders affect one billion people globally, governments spend only about 2% of their health budgets on these disorders, and most people lack access to treatment. With its focus on power, political science could deepen knowledge on vulnerabilities to mental illness and explain weak policy responses. By illustrating how various forms of power pertaining to governance, knowledge, and moral authority work through the concepts of issue framing, collective action, and institutions, the article shows that political science can deepen knowledge on this global health issue. Political science can analyse how incomplete knowledge leads to contentious framing, thus hobbling advocacy. It can explain why states shirk their obligations in mental health, and it can question how incentives drive mental health mobilisation. The discipline can uncover how power undergirds institutional responses to global mental health at the international, national, and community levels. Political science should collaborate with other social sciences in research networks to improve policy outcomes.
Background: Gestational cadmium exposure may impair fetal growth. Coal smoke has largely been une... more Background: Gestational cadmium exposure may impair fetal growth. Coal smoke has largely been unexplored as a source of cadmium exposure. We investigated the relationship between gestational cadmium exposure and fetal growth, and assessed coal smoke as a potential source of airborne cadmium, among non-smoking pregnant women in Ulaanbaatar, Mongolia, where coal combustion in home heating stoves is a major source of outdoor and indoor air pollution. Methods: This observational study was nested within the Ulaanbaatar Gestation and Air Pollution Research (UGAAR) study, a randomized controlled trial of portable high efficiency particulate air (HEPA) filter air cleaner use during pregnancy, fetal growth, and early childhood development. We measured third trimester blood cadmium concentrations in 374 out of 465 participants who had a live birth. We used multiple linear and logistic regression to assess the relationships between log 2-transformed maternal blood cadmium concentrations and birth weight, length, head circumference, ponderal index, low birth weight, small for gestational age, and preterm birth in crude and adjusted models. We also evaluated the relationships between log 2-transformed blood cadmium concentrations and the density of coal-burning stoves within 5000 m of each participant's apartment as a proxy of coal smoke emissions from home heating stoves. Results: The median (25th,75th percentile) blood cadmium concentration was 0.20 (0.15, 0.29) μg/L. A doubling of blood cadmium was associated with a 95 g (95% CI: 34, 155 g) reduction in birth weight in adjusted models. An interquartile range increase in coal stove density (from 3.4 to 4.9 gers/hectare) surrounding participants' apartments was associated with a 12.2% (95% CI: 0.3, 25.6%) increase in blood cadmium concentrations. Conclusions: Gestational cadmium exposure was associated with reduced birth weight. In settings where coal is a widely used fuel, cadmium may play a role in the putative association between air pollution and impaired fetal growth.
Background: Indoor and outdoor fine particulate matter (PM 2.5) are both leading risk factors for... more Background: Indoor and outdoor fine particulate matter (PM 2.5) are both leading risk factors for death and disease, but making indoor measurements is often infeasible for large study populations. Methods: We developed models to predict indoor PM 2.5 concentrations for pregnant women who were part of a randomized controlled trial of portable air cleaners in Ulaanbaatar, Mongolia. We used multiple linear regression (MLR) and random forest regression (RFR) to model indoor PM 2.5 concentrations with 447 independent 7-day PM 2.5 measurements and 87 potential predictor variables obtained from outdoor monitoring data, questionnaires, home assessments, and geographic data sets. We also developed blended models that combined the MLR and RFR approaches. All models were evaluated in a 10-fold cross-validation. Results: The predictors in the MLR model were season, outdoor PM 2.5 concentration, the number of air cleaners deployed, and the density of gers (traditional felt-lined yurts) surrounding the apartments. MLR and RFR had similar performance in cross-validation (R 2 = 50.2%, R 2 = 48.9% respectively). The blended MLR model that included RFR predictions had the best performance (cross validation R 2 = 81.5%). Intervention status alone explained only 6.0% of the variation in indoor PM 2.5 concentrations. Conclusions: We predicted a moderate amount of variation in indoor PM 2.5 concentrations using easily obtained predictor variables and the models explained substantially more variation than intervention status alone. While RFR shows promise for modeling indoor concentrations, our results highlight the importance of out-of-sample validation when evaluating model performance. We also demonstrate the improved performance of blended MLR/RFR models in predicting indoor air pollution. Capsule To our knowledge, this is the first application and evaluation of random forest regression and blended models for modeling indoor air pollution concentrations, and these techniques show promise for estimating exposure in health risk assessment and epidemiology. Participant Group Intervention status % of participants Winter Spring Summer Fall Full UGAAR Cohort (N = 512) Control (N = 253) 28 Received air cleaner (N =77) 33 Received 2 air cleaners (N = 182) 29 28 16 All 31 27 17 Participants included in model development 2 (N = 342) Control (N = 212) 28 24 23
Background: Fine particulate matter (PM 2.5) exposure may impair fetal growth. Aims/objectives: O... more Background: Fine particulate matter (PM 2.5) exposure may impair fetal growth. Aims/objectives: Our aim was to assess the effect of portable high efficiency particulate air (HEPA) filter air cleaner use during pregnancy on fetal growth. Methods: The Ulaanbaatar Gestation and Air Pollution Research (UGAAR) study is a single-blind randomized controlled trial conducted in Ulaanbaatar, Mongolia. Non-smoking pregnant women recruited at ≤18 weeks gestation were randomized to an intervention (1-2 air cleaners in homes from early pregnancy until childbirth) or control (no air cleaners) group. Participants were not blinded to their intervention status. Demographic, health, and birth outcome data were obtained via questionnaires and clinic records. We used unadjusted linear and logistic regression and time-to-event analysis to evaluate the intervention. Our primary outcome was birth weight. Secondary outcomes were gestational age-adjusted birth weight, birth length, head circumference, gestational age at birth, and small for gestational age. The study is registered at ClinicalTrials.gov (NCT01741051). Results: We recruited 540 participants (272 control and 268 intervention) from January 9, 2014 to May 1, 2015. There were 465 live births and 28 losses to follow up. We previously reported a 29% (95% CI: 21, 37%) reduction in indoor PM 2.5 concentrations with portable HEPA filter air cleaner use. The median (25th, 75th percentile) birth weights for control and intervention participants were 3450 g (3150, 3800 g) and 3550 g (3200, 3800 g), respectively (p = 0.34). The intervention was not associated with birth weight (18 g; 95% CI: −84, 120 g), but in a pre-specified subgroup analysis of 429 term births the intervention was associated with an 85 g (95% CI: 3, 167 g) increase in mean birth weight. Conclusions: HEPA filter air cleaner use in a high pollution setting was associated with greater birth weight only among babies born at term.
describe anthropological engagements with the global public health enterprise that we could not h... more describe anthropological engagements with the global public health enterprise that we could not have imagined in the late 1970s and early 1980s, when my coeditors and I were developing the ideas that led to the publication of Anthropology and Epidemiology (Janes, Stall, and Gifford 1986). Medical anthropology was a young field and we were amongst the first few cohorts of students to receive PhDs in it. Many of us had been motivated to consider anthropological contributions to public health through the mentorship of Fred Dunn, a physician-anthropologistepidemiologist who was deeply committed to the utility of medical anthropology in communicable disease epidemiology (Inhorn and Janes 2007). The exploration of the social contexts of sickness was not, of course, a novel line of thinking: in many ways we were simply building on genealogies of knowledge that harkened back to the work of Rudolf Virchow, Friedrich Engels, Emile Durkheim, and others (Trostle 1986b, 1986a). Exemplary thinking had already been done by Sidney Kark and his colleagues and students in South Africa, which in many ways laid the foundation for the development of an anthropologically informed social epidemiology (see Kark and Abramson 2003); Alexander and Dorothea Leighton and their colleagues in their often-neglected work on the social and cultural factors
Background: Indoor and outdoor exposures to fine particulate matter (PM2.5) are both leading risk... more Background: Indoor and outdoor exposures to fine particulate matter (PM2.5) are both leading risk factors for death and disease, but collecting indoor measurements is often infeasible for large stu...
Refugee newcomers almost invariably face "food" culture shock and are at greater risk of food ins... more Refugee newcomers almost invariably face "food" culture shock and are at greater risk of food insecurity due to slow-to-evolve institutions. Community programs can help boost refugee newcomer con dence through knowledge exchange during intercultural culinary experiences. The originally proposed program was "Breaking Down the Walls (BDTW)-Building Integration and Cultural Appreciation through Shared Food Experiences with Refugee Newcomers". With the restrictions set in place due to the COVID-19 pandemic, adaptations were made to the BDTW program. Speci cally, the program's scope was greatly reduced and the program itself shifted to a virtual environment. The nal deliverables for this program included: 1) a framework/guide for conducting intercultural cooking events; and 2) an Online cultural brokerage training tool to help users to grasp some of the food-related challenges faced by newcomers to Canada. To best identify the challenges, successes, and e cacy of conducting community-based research, the team adopted a Developmental Evaluation approach, which is often used in complex settings and evolving scenarios such as the COVID-19 pandemic. The themes which emerged from interviews with participants were further distilled into broader areas of the COVID-19 pandemic, collaboration, and equity. Programs like BDTW have the potential to create infrastructure for newcomer nutrition programming that is integrated and streamlined as a long-term intervention. This type of programming would help shift care practices from sporadically addressing health/nutrition and settlement issues as they arise to a system that proactively anticipates nutritional needs from day one, ultimately promoting long-term health and mental wellbeing among newcomer populations.
Introduction: South Asian communities comprise one of the fastest-growing populations in Canada, ... more Introduction: South Asian communities comprise one of the fastest-growing populations in Canada, but there is a paucity of research on if and how immigrant men use sexual health services. Objectives: Our study aimed to understand factors influencing sexual health service use by South Asian immigrant men living in Ontario, Canada. Methods: An interpretive description (ID) research methodology was used, followed by Braun and Clarke’s thematic guidelines to collect and analyze data. Altogether, 18 semi-structured interviews were conducted between May and July 2021 with South Asian immigrant men between 20 and 45 years of age in Ontario. Results: We found that culture shaped the overall perception and use of sexual health services, while the perceived severity of sexual illness also affected the utilization of preventative care. Moreover, there are taboos about sexual health, and while sex positivity and sex negativity exist, sexual health information is shared with trusted sources. We ...
PurposePatient experience (PE) evaluation can identify critical issues in healthcare quality. Var... more PurposePatient experience (PE) evaluation can identify critical issues in healthcare quality. Various methods are used for PE evaluation in the healthcare system in Ontario; however, evidence suggests that PE evaluation is not systematically performed and has not received substantial buy-in from healthcare providers. This study explores the perspectives of healthcare providers, managers and policymakers in Ontario on PE evaluation methods, barriers, utility and reliability.Design/methodology/approachThe study used a qualitative descriptive design. Twenty-one semistructured interviews were conducted with healthcare providers, managers and policymakers in Ontario between April 2018 and May 2019. The authors used thematic analysis to analyze the data. The Consolidated Criteria for Reporting Qualitative Research quality criteria were used.FindingsBarriers to PE evaluation include evaluation cost and the time and effort required to collect and analyze the data. Several factors affect the...
PurposeSocial media has made a revolutionary change in the relationship between the customers and... more PurposeSocial media has made a revolutionary change in the relationship between the customers and business or service providers by enabling customers to publish and share feedback and views about product or service quality. This revolutionary change has not been echoed in some healthcare systems. This study analyses the social media policies of healthcare regulatory authorities in Ontario and explores how these policies encourage or discourage healthcare professionals' use of social media for collecting patient stories and understanding patient experience.Design/methodology/approachThe study used qualitative content analysis to analyse the policy documents, focusing on the manifest themes in these documents. It used convenient sampling to select 12 organizations, including regulating and licensing bodies and health service delivery organizations in Ontario. The authors collected 24 documents from these organizations, including policies, practice standards and social media learni...
Globally it is recognised that climate change impact is manifested through severe weather events ... more Globally it is recognised that climate change impact is manifested through severe weather events that cause, for example, flooding. Floods have large social consequences for communities and individuals. This paper investigates the impact of flooding on water supply and sanitation conditions together with flood-induced health problems on the Barotse floodplain in Zambia. The study also explored rural response measures and adaptation strategies. This study relied on intensive field investigation in May 2021 where 99 households from different villages in the floodplain were randomly sampled to participate in a questionnaire survey. Key informants, including government officials from the Ministries of Health, Agriculture, and Local Government and Housing, were also interviewed. The findings showed that water supply and sanitation conditions are severely interrupted during flood periods, and this leads to various waterborne diseases. The findings further revealed that all pit latrines in...
The International Journal of Health Planning and Management, 2021
There has been a growing use of social media by patients to share their healthcare experiences an... more There has been a growing use of social media by patients to share their healthcare experiences and produce information that can be helpful to other patients seeking healthcare services. These stories can reveal issues in healthcare quality. However, faced with the inherent risks of social media, healthcare providers have been skeptical about the value of these stories, and many healthcare systems have adopted restrictive and protective policies to control the use of social media by healthcare providers. This study explores healthcare providers' and administrators' perspectives on patient stories on social media and whether they can use the stories to evaluate healthcare experiences. Semi-structured interviews (n = 21) were conducted with healthcare providers and administrators, including physicians, nurses, and quality managers in Ontario, Canada, between April 2018 and May 2019. Inductive and data-driven thematic analysis was used to analyze the data. Several barriers prevent healthcare providers from realizing the benefits of social media, including concerns about the quality of patients' feedback, the professional codes of conduct, and the time and effort required to process these stories. The study findings suggest that cultural changes in the healthcare system might be required to foster the use of social media for healthcare quality improvement and enable the development of a safe patient-provider communication environment that facilitates the exchange of constructive feedback between the two parties without the fear of legal consequences, breaches of patient privacy, or violation of professional codes of conduct.
NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 2021
Scholarship on the health impacts of resource extraction displays prominent gaps and apparent cor... more Scholarship on the health impacts of resource extraction displays prominent gaps and apparent corporate and neocolonial footprints that raise questions about how science is produced. We analyze production of knowledge, on the health impacts of mining, carried out in relation to the Canadian International Resources and Development Institute (CIRDI), a university-based organization with substantial extractive industry involvement and links to Canada’s mining-dominated foreign policy. We use a “political ecology of knowledge” framework to situate CIRDI in the context of neoliberal capitalism, neocolonial sustainable development discourses, and mining industry corporate social responsibility techniques. We then document the interactions of specific health disciplinary conventions and knowledges within CIRDI-related research and advocacy efforts involving a major Canadian global health organization. This analysis illustrates both accommodation and resistance to large-scale political econ...
While most performance judgements are value-relative, in health systems reform it is important to... more While most performance judgements are value-relative, in health systems reform it is important to focus on intermediate performance measures like healthcare access, quality of care and efficiency in healthcare on health status of population, the satisfaction of patients, and the degree to which services are made equitable. However, to date these concepts are not well-defined, remain fairly ambiguous and, consequently, are also not well-measured. Therefore, such concepts do not provide sufficient information to inform changes to the health system that may improve population level outcomes related to structural factors. Our paper established an argument and from our viewpoints we provide a more conceptual clarification on how these three intermediate variables may shape assessments in health system performance, while drawing from the Canadian healthcare system performance gaps and placing them as evidence. We found an immediate need for patient-centred outcome measures in service and ...
The International Journal of Health Planning and Management, 2021
BackgroundPatient experience has a direct impact on patients' engagement in healthcare, their... more BackgroundPatient experience has a direct impact on patients' engagement in healthcare, their commitment to treatment plans, and their relationship with their healthcare providers, all of which can impact their health outcomes. The complexity of the healthcare system, the increasing health needs of the population, and the priority and knowledge differences among healthcare stakeholders impact how they conceptualize and seek to achieve the ideal patient experience and the weights that they give to different elements of this experience.AimsThis study sought to understand the perspectives of healthcare providers and administrators in Ontario regarding the factors affecting the patient experience.Materials & MethodsQualitative data were collected between April 2018 and May 2019. Twenty‐one semi‐structured interviews were conducted. Interviewees included physicians, nurses, optometrists, dietitians, quality managers, and policymakers. Thematic analysis was used to analyse the data, u...
This article outlines an agenda for political science engagement with global mental health. Other... more This article outlines an agenda for political science engagement with global mental health. Other social sciences have tackled the topic, investigating such questions as the link between poverty and mental health disorders. Political science is noticeably absent from these explorations. This is striking because mental health disorders affect one billion people globally, governments spend only about 2% of their health budgets on these disorders, and most people lack access to treatment. With its focus on power, political science could deepen knowledge on vulnerabilities to mental illness and explain weak policy responses. By illustrating how various forms of power pertaining to governance, knowledge, and moral authority work through the concepts of issue framing, collective action, and institutions, the article shows that political science can deepen knowledge on this global health issue. Political science can analyse how incomplete knowledge leads to contentious framing, thus hobbling advocacy. It can explain why states shirk their obligations in mental health, and it can question how incentives drive mental health mobilisation. The discipline can uncover how power undergirds institutional responses to global mental health at the international, national, and community levels. Political science should collaborate with other social sciences in research networks to improve policy outcomes.
Background: Gestational cadmium exposure may impair fetal growth. Coal smoke has largely been une... more Background: Gestational cadmium exposure may impair fetal growth. Coal smoke has largely been unexplored as a source of cadmium exposure. We investigated the relationship between gestational cadmium exposure and fetal growth, and assessed coal smoke as a potential source of airborne cadmium, among non-smoking pregnant women in Ulaanbaatar, Mongolia, where coal combustion in home heating stoves is a major source of outdoor and indoor air pollution. Methods: This observational study was nested within the Ulaanbaatar Gestation and Air Pollution Research (UGAAR) study, a randomized controlled trial of portable high efficiency particulate air (HEPA) filter air cleaner use during pregnancy, fetal growth, and early childhood development. We measured third trimester blood cadmium concentrations in 374 out of 465 participants who had a live birth. We used multiple linear and logistic regression to assess the relationships between log 2-transformed maternal blood cadmium concentrations and birth weight, length, head circumference, ponderal index, low birth weight, small for gestational age, and preterm birth in crude and adjusted models. We also evaluated the relationships between log 2-transformed blood cadmium concentrations and the density of coal-burning stoves within 5000 m of each participant's apartment as a proxy of coal smoke emissions from home heating stoves. Results: The median (25th,75th percentile) blood cadmium concentration was 0.20 (0.15, 0.29) μg/L. A doubling of blood cadmium was associated with a 95 g (95% CI: 34, 155 g) reduction in birth weight in adjusted models. An interquartile range increase in coal stove density (from 3.4 to 4.9 gers/hectare) surrounding participants' apartments was associated with a 12.2% (95% CI: 0.3, 25.6%) increase in blood cadmium concentrations. Conclusions: Gestational cadmium exposure was associated with reduced birth weight. In settings where coal is a widely used fuel, cadmium may play a role in the putative association between air pollution and impaired fetal growth.
Background: Indoor and outdoor fine particulate matter (PM 2.5) are both leading risk factors for... more Background: Indoor and outdoor fine particulate matter (PM 2.5) are both leading risk factors for death and disease, but making indoor measurements is often infeasible for large study populations. Methods: We developed models to predict indoor PM 2.5 concentrations for pregnant women who were part of a randomized controlled trial of portable air cleaners in Ulaanbaatar, Mongolia. We used multiple linear regression (MLR) and random forest regression (RFR) to model indoor PM 2.5 concentrations with 447 independent 7-day PM 2.5 measurements and 87 potential predictor variables obtained from outdoor monitoring data, questionnaires, home assessments, and geographic data sets. We also developed blended models that combined the MLR and RFR approaches. All models were evaluated in a 10-fold cross-validation. Results: The predictors in the MLR model were season, outdoor PM 2.5 concentration, the number of air cleaners deployed, and the density of gers (traditional felt-lined yurts) surrounding the apartments. MLR and RFR had similar performance in cross-validation (R 2 = 50.2%, R 2 = 48.9% respectively). The blended MLR model that included RFR predictions had the best performance (cross validation R 2 = 81.5%). Intervention status alone explained only 6.0% of the variation in indoor PM 2.5 concentrations. Conclusions: We predicted a moderate amount of variation in indoor PM 2.5 concentrations using easily obtained predictor variables and the models explained substantially more variation than intervention status alone. While RFR shows promise for modeling indoor concentrations, our results highlight the importance of out-of-sample validation when evaluating model performance. We also demonstrate the improved performance of blended MLR/RFR models in predicting indoor air pollution. Capsule To our knowledge, this is the first application and evaluation of random forest regression and blended models for modeling indoor air pollution concentrations, and these techniques show promise for estimating exposure in health risk assessment and epidemiology. Participant Group Intervention status % of participants Winter Spring Summer Fall Full UGAAR Cohort (N = 512) Control (N = 253) 28 Received air cleaner (N =77) 33 Received 2 air cleaners (N = 182) 29 28 16 All 31 27 17 Participants included in model development 2 (N = 342) Control (N = 212) 28 24 23
Background: Fine particulate matter (PM 2.5) exposure may impair fetal growth. Aims/objectives: O... more Background: Fine particulate matter (PM 2.5) exposure may impair fetal growth. Aims/objectives: Our aim was to assess the effect of portable high efficiency particulate air (HEPA) filter air cleaner use during pregnancy on fetal growth. Methods: The Ulaanbaatar Gestation and Air Pollution Research (UGAAR) study is a single-blind randomized controlled trial conducted in Ulaanbaatar, Mongolia. Non-smoking pregnant women recruited at ≤18 weeks gestation were randomized to an intervention (1-2 air cleaners in homes from early pregnancy until childbirth) or control (no air cleaners) group. Participants were not blinded to their intervention status. Demographic, health, and birth outcome data were obtained via questionnaires and clinic records. We used unadjusted linear and logistic regression and time-to-event analysis to evaluate the intervention. Our primary outcome was birth weight. Secondary outcomes were gestational age-adjusted birth weight, birth length, head circumference, gestational age at birth, and small for gestational age. The study is registered at ClinicalTrials.gov (NCT01741051). Results: We recruited 540 participants (272 control and 268 intervention) from January 9, 2014 to May 1, 2015. There were 465 live births and 28 losses to follow up. We previously reported a 29% (95% CI: 21, 37%) reduction in indoor PM 2.5 concentrations with portable HEPA filter air cleaner use. The median (25th, 75th percentile) birth weights for control and intervention participants were 3450 g (3150, 3800 g) and 3550 g (3200, 3800 g), respectively (p = 0.34). The intervention was not associated with birth weight (18 g; 95% CI: −84, 120 g), but in a pre-specified subgroup analysis of 429 term births the intervention was associated with an 85 g (95% CI: 3, 167 g) increase in mean birth weight. Conclusions: HEPA filter air cleaner use in a high pollution setting was associated with greater birth weight only among babies born at term.
describe anthropological engagements with the global public health enterprise that we could not h... more describe anthropological engagements with the global public health enterprise that we could not have imagined in the late 1970s and early 1980s, when my coeditors and I were developing the ideas that led to the publication of Anthropology and Epidemiology (Janes, Stall, and Gifford 1986). Medical anthropology was a young field and we were amongst the first few cohorts of students to receive PhDs in it. Many of us had been motivated to consider anthropological contributions to public health through the mentorship of Fred Dunn, a physician-anthropologistepidemiologist who was deeply committed to the utility of medical anthropology in communicable disease epidemiology (Inhorn and Janes 2007). The exploration of the social contexts of sickness was not, of course, a novel line of thinking: in many ways we were simply building on genealogies of knowledge that harkened back to the work of Rudolf Virchow, Friedrich Engels, Emile Durkheim, and others (Trostle 1986b, 1986a). Exemplary thinking had already been done by Sidney Kark and his colleagues and students in South Africa, which in many ways laid the foundation for the development of an anthropologically informed social epidemiology (see Kark and Abramson 2003); Alexander and Dorothea Leighton and their colleagues in their often-neglected work on the social and cultural factors
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Papers by Craig Janes